[Congressional Record Volume 163, Number 104 (Monday, June 19, 2017)]
[Senate]
[Pages S3580-S3605]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                         Healthcare Legislation

  Mr. President, I was elected to the Senate in 2000. I came here in 
2001. Two days after I was elected, I called Tom Daschle, the 
Democratic leader in the Senate, and I said: I understand I need to 
explain my choice and preferences for committees to you.
  He said: Yes. You should give me a letter today that tells me which 
committees you would like to be on.
  I am not sure how they work it on the Republican side, but that is 
the way we did it here and, I presume, still do.
  I said: My first three choices to be on committees would be--my first 
choice would be the Finance Committee, my second choice would be the 
Finance Committee, and my third choice would be the Finance Committee.
  He said: You want to be on the Finance Committee, don't you?
  I said: Yes, I do.
  He said: So does everybody else. You have to get in line.
  So I did. It took me 8 years. I got on some great committees in the 
interim, including the Banking Committee, Commerce, Environment and 
Public Works, Homeland Security, Governmental Affairs, and others as 
well, even Aging for a while. Eventually I got on the Finance 
Committee--in 2009. That was the year we had a new President, Barack 
Obama, and a new Vice President, Joe Biden. The hope from our new 
leaders was that we would do something Presidents since Harry Truman 
have wanted to do, and that was to provide healthcare coverage for just 
about everybody in our country. We weren't sure exactly how to go about 
it.
  We did our homework and found that in 1993, when First Lady Hillary 
Clinton came up and worked on something called HillaryCare, the 
Republicans felt like they had to come up with an alternative, which 
was provided by the people at Heritage, a Republican think tank. What 
they came up with had five components to it and was introduced as 
stand-alone legislation by John Chafee and cosponsored by Orrin Hatch, 
Chuck Grassley, and I think about 20 other Republican Senators.
  In the end, HillaryCare didn't go anywhere. The Chafee bill didn't go 
anywhere, but it lived on beyond 1993 and that Congress. When Mitt 
Romney was Governor of Massachusetts and was going to run for 
President, he took that 1993 legislation, which called for creating 
exchanges in every State and marketplaces and large purchasing pools 
where people who didn't have healthcare coverage could buy healthcare 
coverage in their State. The 1993 legislation had sliding-scale tax 
credits so people buying coverage on the exchanges could get a tax 
credit to help buy down the cost of their coverage. The idea was that 
folks whose incomes were low would get a bigger tax credit, and those 
whose incomes got larger and larger would eventually not qualify for 
anything at all. But there was a sliding-scale tax credit.
  Another provision in the 1993 legislation Mitt Romney borrowed was 
the idea of having individual mandates so that people had to get 
coverage in Massachusetts, and if they didn't, they had to pay a fine. 
The idea was that we need for folks to get coverage. We need to make 
sure these exchanges--if they were going to have them in the State, 
that they wouldn't have people just sign up for coverage in the 
exchanges when they get sick and run up the tab a lot for the insurance 
companies. The insurance companies said they couldn't make money doing 
that. So in Massachusetts, they had the individual mandate.
  They also had an employer mandate that employers with a certain 
number of employees had to provide coverage for their people. They 
didn't have to pay for it all, but they had to offer them coverage.
  The last thing Governor Romney took from the 1993 legislation by 
Senator Chafee and others was the idea that insurance companies could 
not deny coverage to folks with preexisting conditions.
  Mitt Romney thought those were pretty good ideas and made them sort 
of the centerpiece of what they called RomneyCare in Massachusetts, 
which became the law and ultimately extended coverage to a lot of 
people who didn't have it.
  Initially, they didn't do a very good job on affordability. I am told 
by folks in Massachusetts that one of the reasons was that the fine 
associated with the individual mandate wasn't very big. Eventually it 
was scaled up, but it took a while to get to a point where young people 
said: I am paying this fine; I may as well get coverage and stop paying 
the fine and get something for my money.
  RomneyCare ended up being pretty successful. He ran for President, 
and one of the linchpins he used is, look, we have already done what 
Barack Obama wants to do. We are already providing healthcare coverage 
for people in my state.
  In any event, in 2009 I ended up on the Finance Committee. We spent a 
huge amount of time in 2009 trying to figure out what this healthcare 
plan should look like that our new President and new Vice President 
wanted us to do. It looked a lot like what was offered in 1993, and it 
looked a lot like what was actually adopted and I think worked with 
relative success in Massachusetts.
  We held a lot of hearings. I remember being on the Finance Committee. 
It seemed like for week after week after week, we had hearings, we had 
roundtables, we had discussions, we had meetings off the floor and on 
the floor to talk about whether it made sense. We went for an extended 
period of time where we had three Democrats and three Republicans on 
the committee who met endlessly to try to figure out what the 
reasonable compromises were that would enable us to extend coverage to 
everybody in an affordable kind of way.
  We ended up having an extensive markup, voting, and debating the 
legislation in both the Finance Committee and the HELP Committee. 
People had the opportunity to offer amendments, a number of which were 
offered and adopted by Democrats and Republicans alike. I don't 
remember exactly, but I seem to recall that in the Health, Education, 
Labor, and Pensions Committee, something like 300 amendments may have 
been offered, 160 by Republicans that were adopted.
  Long story short, we finally had a chance to finish the debate, and 
it became law.
  I know our Republican friends don't feel like they had much of a 
chance to be involved, but my recollection is that there was a lot of 
involvement by both sides. I thought at times that the debate on this 
legislation would never end. It finally did, and we finally passed it 
on a close margin.
  The reason I bring this up is that was my first year on the Finance 
Committee. I loved it. I was on there with Senator Stabenow and a 
number of others, and we were actually legislating. It was fun. It was 
challenging. We were trying to develop consensus. I want us to do that 
again.
  As good as we think the Affordable Care Act is, I know it is not 
perfect. I think everybody in this Chamber knows it is not perfect. But 
the idea of preserving what needs to be preserved and fixing what needs 
to be fixed is what we ought to be about.
  As smart as our Republican friends are, they can't do this by 
themselves, and as smart as we like to think we are, neither can we. In 
this case, we would be a lot better off doing this together. I know 
Senator Schumer has asked the Republican leader for us to meet later 
this week--maybe Thursday--in the Old Senate Chamber and just talk it 
over.

[[Page S3581]]

  John Kennedy used to say that we shouldn't be afraid to negotiate. He 
had a great quote about being afraid. He basically said we should never 
be afraid to negotiate or talk. I think that probably pertains to us 
today.
  I thank the Senator from New Jersey for yielding his time to me to 
give me a chance to say something again to my Republican colleagues.
  I was in Tanzania, Africa, a couple of years ago for an Aspen 
Institute seminar with Democrats and Republicans, House and Senate. I 
learned a lot about Africa. One of the things I learned was a great 
African proverb. A lot of people have heard it; I had never heard it 
before. It goes something like this: If you want to go fast, go alone. 
If you want to go far, go together. On something this important, we 
need to go together, and we will be glad we did.
  The PRESIDING OFFICER. The Senator from California.
  Ms. HARRIS. Mr. President, Senator Carper talked about Tanzania. It 
reminds me of a greeting I have often heard from people who live in 
various African countries. When you meet someone for the first time, 
instead of what we would normally say--``Pleased to meet you''--the 
greeting is ``I see you.'' I see you. I think that really is part of 
our concern here: Do we see the people who will be impacted in the way 
they are actually living their lives, and do we understand, if we see 
them, that this bill will not be in their best interests?
  Right now, for example, we know 13 Senators--all Republicans--are 
crafting a bill. This bill would restructure our Nation's entire 
healthcare system, which, when we add up what Americans spend on 
hospitals, doctors, prescription drugs, and all the rest, we understand 
it makes up one-sixth of our economy. It would affect the lives of 
everyone--our parents, grandparents, those who are in need of 
caregiving, our children struggling with asthma or opioid abuse, our 
spouses, who may be battling cancer.
  What is equally distressing is that this bill is being written in 
secret. The chairman of the Finance Committee says he has not seen the 
bill. The Secretary of Health and Human Services says he has not seen 
the bill. The American people, the people we all represent, have 
certainly not seen the bill.
  I think the American people deserve better. This bill is being 
written entirely along partisan lines without any attempt to bring 
Democrats on board, and the American people deserve better. This bill 
is being written and rushed through the Senate with hardly any time to 
debate the cost or the details of this proposal, and the American 
people deserve better.
  I remember when our colleagues across the aisle said the Affordable 
Care Act was being rammed down the American people's throats in the 
middle of the night. The ACA, in fact, went through 106 public 
hearings. It incorporated more than 170 Republican amendments. The 
whole process took an entire year. But this healthcare plan involves no 
hearings, no bill text, and no transparency at all.
  As Senators, we were sent here to represent the American people. We 
answer to the American people.
  Why are my colleagues from across the aisle trying to put one over on 
the American people? I have met folks all across California and this 
country, and they see what is happening. They know that if this bill 
were as wonderful as its proponents would like us to believe, it would 
be out in the open.
  The American people deserve greater transparency. Even though the 
authors of this proposal have tried to conceal the details of their 
plan, we know enough to know this bill would be nothing short of a 
disaster. We know because we have been told it is about 80 percent the 
same as the bill that was passed by the House--a bill so catastrophic 
that even the President of the United States who hailed its passage now 
calls it ``mean.''
  We know it would throw 23 million Americans off their health 
insurance within a decade, including putting 4 to 5 million 
Californians at risk of losing coverage. We know it would raise costs 
for middle-class families and seniors. In every county of California, 
average monthly premium costs would go up while financial support to 
pay premiums would fall.
  We know it would put Americans with preexisting conditions at risk 
and leave people who need maternity care or opioid treatment without 
coverage or force them to pay huge out-of-pocket costs. We know it 
would cut about $834 billion from Medicaid, which means less money for 
families to pay for nursing homes, to support children with special 
needs, or to treat substance abuse. We need the Affordable Care Act to 
be in place, in a way that we fix what is wrong, but we mend what is 
broken and not repeal it altogether.
  I recently visited a really remarkable treatment clinic in Los 
Angeles. It is called the Martin Luther King Jr. Outpatient Center. 
Everyone from the doctors to the patients can tell you that when 4,600 
Californians are dying every year from substance abuse and opioid 
overdoses, it is wrong and irrational to cut Medicaid.
  It really makes you wonder why anyone would support this bill. How 
does this bill help real people with real challenges?
  At a healthcare rally in Los Angeles in January, I met a woman named 
Tonia. Before the ACA, she had signed up for insurance just long enough 
to see a doctor, have a few tests done, and fill a prescription. Then 
she would realize she couldn't pay and couldn't afford to pay for the 
insurance beyond that. She said:

       It's the worst feeling in the world to have to tell your 
     doctor--who is trying to make you well--that you cannot 
     afford the treatment prescribed.

  Tonia told me:

       Before the Affordable Care Act, living without health 
     coverage was a nightmare in this country.

  She went on to say:

       But that has all changed, and thanks to the ACA I can now 
     see a doctor when I need to, monitor my condition, and stay 
     healthy so that I can keep working and contribute to our 
     nation's economy. If the Republicans in Congress repeal the 
     law, I don't know what I will do.

  I ask, How does the Republican healthcare plan help Tonia?
  Another woman, Krista, told me:

       I am married with four children, one of whom is a 10-year-
     old type one diabetic. He requires daily active insulin 
     management to stay alive--24 hours a day, 7 days a week.

  She went on to say:

       Healthcare is not optional for us; even with health 
     insurance, diabetes management is the type of thing that can 
     bankrupt you. Without health insurance, I can't imagine. ACA 
     is a huge relief for my family.

  I ask, How does this bill help Krista and her family?
  Then, there is Rhett, in Marin County. More than 7 years ago, he was 
diagnosed with leukemia. Rhett is 9 years old. He says:

       Cancer cells are the bad guys.

  This is what he wrote me.

       For 3\1/2\ years I took chemo to get the bad guys out. I 
     had more than one thousand doses of chemotherapy. . . . My 
     parents had to tell my sister that I might die of cancer.

  And then he went on to write:

       Thanks to my doctors and nurses, my family and friends, my 
     church and my community, and the Affordable Care Act . . . 
     now I'm Gone-with-the-Cancer. I have a pre-existing 
     condition. Thanks to the Affordable Care Act, my parents 
     don't worry about losing coverage.

  A 9-year-old Rhett is showing us the way. How does this bill help 
Rhett?
  I don't know the party affiliation of any of these folks. I don't 
know if they are Democrats. I don't know if they are Republicans. I 
don't know if they are Independents. I don't know if they are members 
of the Green Party. I am not asking them those questions. I am asking 
them: How are you doing? What is helping you? What do you need? How 
will this impact you?
  I know I am one of two Senators whom they have. When it comes to 
their needs and their need to be represented in the U.S. Congress and 
their need to be heard and their need to be seen, party affiliation 
should not matter. What should matter are the needs of the American 
people.
  Regardless of whom they vote for in a partisan election, I am certain 
of this. This healthcare plan that is being proposed by my colleagues 
from across the aisle will not solve their problems. It will only 
create more problems and potentially devastate people's lives.
  To my colleagues I say, this shouldn't be a matter of supporting this 
bill automatically if you are a Republican or objecting just because 
you are a Democrat; this is about what is right and what is wrong.

[[Page S3582]]

  If you know this bill is bad, stand up and stop it. Speak that truth. 
Now is not the time to keep quiet and hope nobody notices. Forget the 
politics. Forget partisan pressure and talk radio and primary ads. 
Instead, just listen to the voices of the American people, not just in 
California but in Nevada, in Arizona, in Ohio, in Alaska, in Maine, in 
Pennsylvania, in West Virginia because they have made themselves 
overwhelmingly clear. Only 20 percent of Americans support this bill.
  A majority opposes it in every State in this country. It is the least 
popular piece of legislation in modern history. I am asking you to 
think about the American people. I am asking you to think about Tonia. 
Think about Krista. Think about Rhett living with leukemia since he was 
just 2\1/2\ years old, undergoing 2\1/2\-hour infusions every night 
with such incredible bravery.
  Let the determination of Americans like Rhett bring us together--a 9-
year-old boy who tells us, in his words: ``Don't repeal the Affordable 
Care Act, Improve it!'' We all agree, the ACA can be improved. It must 
be improved. It isn't perfect. I am ready to work with anyone who 
really wants to make it better.
  Instead of playing politics, instead of playing politics with public 
health and people's lives, we can actually work together to strengthen 
our healthcare system.
  In fact, I am proud to have recently cosponsored a bill with Senator 
Dianne Feinstein and a number of my Democratic colleagues. Our bill 
would make it safer and easier for middle-class Americans to buy 
insurance if they currently don't qualify for any help paying their 
premiums.
  These are the kinds of solutions Democrats can get behind. These are 
the kinds of solutions that would help and not hurt the people we 
represent. We took an oath to represent all the people. I am asking 
every Member of this Chamber to think long and hard about the 
consequences of this bill. Think about the responsibility we have been 
entrusted with.
  We owe it to the American people to tell the truth, not to hide it. 
We owe it to the American people to solve real problems, not to 
manufacture new ones. We owe it to the American people to do the job we 
were sent here to do.
  I urge my colleagues to vote down this bill and stand up for the 
people we represent and serve.
  I yield back.
  The PRESIDING OFFICER. The Senator from Nevada.
  Ms. CORTEZ MASTO. Mr. President, I rise to join my colleagues to 
speak out on the secret healthcare legislation that Republicans are 
attempting to jam through the Senate without any public review or 
consideration.
  This is an insult to the American people. It is a shameful abdication 
of the role of a U.S. Senator to represent the concerns and priorities 
of the people of a State and country. We were elected to be a voice for 
the people of our individual States. What I am hearing loud and clear 
from my State is: Keep the Affordable Care Act. Do not repeal it. Keep 
it, and work together to improve it.
  Like my colleagues, I wish to share the story of one of the many 
Nevadans who have contacted me to share their story about the ACA and 
why they so desperately want to avoid its repeal.
  Jessica and her husband own a brewery in Reno, NV, and I was lucky 
enough to get to meet and speak with her in person when I was home last 
month touring the Community Health Alliance Center.
  After meeting with her, I had the opportunity to sit and talk with so 
many incredible people--doctors, nurses, people who care about the very 
faces of women, men, and children we are talking about tonight. This is 
Jessica's letter to me, and this is what I would like to share with 
you, what she wrote to me.

       Dear Senator Cortez Masto,
       I am a resident of Nevada, a small business owner, and a 
     mother. I am writing to express my views about the Affordable 
     Care Act. The Affordable Care Act has had a tremendously 
     positive effect on my life, and I would like to share my 
     story with you.
       The Affordable Care Act saved my small business.
       When the Patient Protection and Affordable Care Act (ACA) 
     was signed into law in 2010, and when it was upheld by the 
     Supreme Court in 2012, my husband and I were in the planning 
     stages of our small business. At the time, my family was 
     provided health insurance through my corporate job. Knowing 
     the ACA would take effect gave me the peace of mind to leave 
     my job and become a full time small business owner. Today, 
     our business, Under the Rose Brewing Company, is celebrating 
     our 4th year in existence, and we are in the beginning stages 
     of a large expansion, which will create many new jobs in 
     Reno. This business would not have survived without my full-
     time dedication. I would not have been able to leave my 
     corporate job without the ability to procure affordable 
     healthcare for my family.
       The Affordable Care Act allowed me to start my family in a 
     healthy way.
       As my husband and I prepared to sign up for our first year 
     of health care with the ACA, we found out that I was 
     pregnant. Prior to the ACA, health insurers were allowed to 
     consider pregnancy a ``pre-existing condition.'' Instead of 
     being denied coverage or charged higher premiums, I was able 
     to receive appropriate and affordable care during my 
     pregnancy through the ACA.
       The Affordable Care Act saved my life and my baby's life.
       30 weeks into my pregnancy, at a regular checkup with our 
     midwife, my husband and I were advised to see a doctor. Since 
     I didn't look sick or feel sick, we hesitated, but our 
     midwife was positive it would be for the best. Our insurance 
     through ACA allowed us to see the recommended OBGYN. Half way 
     through our appointment he became very concerned and rushed 
     me into the hospital. My son was born by emergency C-section 
     a few hours later. Several doctors agreed that neither the 
     baby nor myself would have survived a further 24 hours of 
     pregnancy. Having health insurance through the ACA allowed 
     my husband and I to seek treatment and care without having 
     to worry about the affordability of following doctor's 
     orders. This is the first time I could say that the ACA 
     saved my life and the life of my beautiful baby boy.
       The Affordable Care Act saved my baby's health [and 
     provided us with health insurance].
       Thus my son was born 9 weeks early and was admitted into 
     the NICU. He stayed in the NICU for 32 days and was under 
     constant doctor care. By the time he left the hospital, we 
     had incurred well over 1 million dollars in total costs. The 
     ACA allowed him to start his life without a cap on his total 
     lifetime healthcare coverage. Prior to the ACA, many NICU 
     babies reach their lifetime limits before even feeling the 
     sunshine on their faces. I am eternally grateful for this 
     provision of the ACA.
       One week after bringing our beautiful baby boy home from 
     our hospital's NICU, I found myself in need of emergency care 
     for a second time. I suffered a postpartum stroke. I was 
     taken to the emergency room and admitted to the hospital for 
     the second time in 2 months. Again, the ACA allowed me to 
     seek treatment and care without worrying about coverage.
       The Affordable Care Act will save my son's healthcare. My 
     son now has a medical issue with his growth. Should the ACA 
     be repealed, amended, or replaced with something less 
     inclusive, this issue will be considered a preexisting 
     condition. The thought of my 18-month-old son being denied 
     coverage, or potentially not being able to afford the 
     healthcare offered to him, makes me sick to my stomach. Why 
     would our lawmakers vote to take this away from him? I 
     implore you to consider the great lengths the Affordable Care 
     Act has gone to not only improve and save lives in my family, 
     but families across the Great State of Nevada. I further 
     implore you to consider the children currently covered and 
     benefitting from the ACA as you contemplate your vote on this 
     significant matter. I strongly urge you to defend this 
     crucial legislation. Too many of your Nevadan constituents 
     rely on this lifesaving, health-saving and financial-saving 
     legislation.
       Thank you for reading my story and considering my views. I 
     am happy to speak directly with you.
       Sincerely, [Jessica] and family.

  Mr. President, I know Jessica's story is one of thousands. I hope my 
colleagues across the aisle think of Jesse and her family and the 
millions of Americans like her who have so much at stake while 
continuing to secretly rewrite our country's healthcare laws.
  Thank you for listening.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Daines). The Senator from Michigan.
  Ms. STABENOW. Mr. President, first, I want to thank the Senator from 
Nevada. We are so pleased that she is here and her voice is so strong 
for the citizens of Nevada and appreciate very much her comments this 
evening.
  I am rising this evening to talk about an issue that affects every 
single person, every single family in Michigan and all across the 
Nation, and that is healthcare. I feel very confident that I can say 
that each one of the 48 members of the Democratic caucus--each and 
every one of us would love to be on this floor working with Republican 
colleagues across the aisle to lower the costs of prescription drugs, 
to lower the out-of-pocket costs of healthcare, to create more 
competition and more

[[Page S3583]]

insurance choices for people in the insurance pools than are there 
now--to basically fix the problems.
  I am proud to be with colleagues tonight because we are not willing 
to support anything that unravels the healthcare system, raises costs, 
takes away healthcare for people, and, on top of that, gives a tax cut 
to the wealthiest Americans, insurance executives, and pharmaceutical 
companies with the dollars that are cut.
  So here we are. The House has passed a bill that, in fact, raises 
costs, takes away healthcare, gives the tax cuts I talked about. Now we 
are in the Senate. The Republicans have a healthcare bill, but they 
will not let us see it.
  I am the ranking Democrat on the Health Subcommittee of the Finance 
Committee. You would think someone would have reached out to have 
conversations with me and members of our subcommittee--members of our 
whole committee--but that has not happened. They are letting the Trump 
administration see it, but not the American public. They are letting K 
Street lobbyists see it. That is probably where I will get a copy 
first--through lobbyists--but not the American public, who will lose 
their healthcare and pay more.
  If you have cancer and you are not going to be able to get coverage, 
if you are going to potentially be dropped or have preexisting 
conditions or get caps put on the number of cancer treatments you can 
receive, I believe you have a right to see this bill. If you have 
epilepsy and will lose your insurance, you have a right to see this 
bill. If you are a woman who will be charged more for insurance and be 
considered to have a preexisting condition just because you are a 
woman, you have a right to see this bill. If you are senior whose rates 
are going to go skyrocketing upward, you have a right to see this bill. 
But the sad fact is, Republicans don't think the American people have a 
right to know or to see this bill or to review it or to comment on it--
to have a chance to give their opinion on it.
  The difference in process couldn't be more clear between the way the 
Affordable Care Act was originally worked on for about 18 months and 
then passed and what is happening right now. In 2009, Republicans 
called for a fair, collaborative, and deliberative legislative process. 
I agree. In fact, we all agree.
  From 2009 to 2010, the Senate Finance Committee held more than 53 
hearings on health reform--hearings, open committee meetings, work 
sessions. As a new member of Finance at that time, I was involved in 
every single one of those, with hours and hours of listening, 
deliberating, people sharing their opinions, and debating. Counting the 
HELP Committee deliberations, there were 100 hearings and committee 
meetings before the bill was finalized and debated to be reported out 
of committee.
  The Republicans have had no hearings--zero hearings. They have had no 
public meetings--zero public meetings.
  During the Finance Committee markup, when we were working through and 
voting out the bill, we considered 135 amendments, often late into the 
night. The final Senate bill included 147 Republican amendments. In the 
end, we were trying to do everything we could to get bipartisan 
support, when it was clear that politically there was not a desire--
even with 147 Republican amendments in the bill--to have a bipartisan 
healthcare bill.
  Republicans will not even allow us to see the bill, let alone amend 
it. Our position is very clear. If there is no hearing, there is no 
vote. We need them to show us the bill.
  There is, I think, a really good reason they will not show us the 
bill. They will not let us see it because it is a disaster for the 
American people. It is a disaster for the people in Michigan whom I 
represent.
  From the House bill, we know that 14 million fewer people will be 
insured after the first year; 23 million fewer people will be insured 
after 10 years. This may change somewhat back and forth. We have no 
idea. But we know the general framework the Senate is working in is the 
same general framework as the House. We know that in 2026, according to 
the Congressional Budget Office, 51 million people under the age of 65 
will be uninsured--no insurance.
  We are told that premiums would go up 20 percent next year, and 
States would be allowed to opt out of key insurance laws that protect 
consumers. To really understand what that means--that means all of the 
decisions about your care go back to the insurance companies, not your 
doctor. Laws that protect people with preexisting conditions are gone. 
Rules that prevent women from being charged more are gone. Laws that 
prevent seniors from being charged more are gone. And the way it used 
to be is that if you got sick, the insurance company could decide to 
drop you. It was the insurance company that said how many cancer 
treatments you were able to receive or mental health visits, if any, 
you would receive. You always paid more than for physical health--the 
same with addiction.
  This all goes away with what is being talked about here. In other 
words, costs are going to go up, and care is going to go down. To add 
insult to injury, all of this is going to go to tax cuts for 
multimillionaires and billionaires, to drug companies and insurance 
companies--while someone is losing nursing home care, cancer 
treatments, maternity care, and children will be unable to go to the 
doctor and parents forced to go back to using the emergency room.
  I want to share with my colleagues what these changes would mean for 
people in Michigan. There are so many people I have talked to, so many 
stories I have heard. I received a letter from a woman named Amy who 
owns a small retail business in Michigan. She has health insurance 
through her husband's job--a small business owner. Amy has chronic 
myeloid leukemia. It is managed with a medication that costs $20,000 a 
month--not a year, a month. After her deductible and 10-percent copay, 
she said she quickly reaches the maximum out-of-pocket expense on her 
insurance each year. Amy wrote:

       Preexisting conditions, maximum out-of-pocket costs and 
     lifetime cap costs are important to me. . . . [Without them] 
     I could never afford my health care. Without the ACA, I could 
     quickly bankrupt my family and still die. . . . Please 
     consider my situation when deciding your vote on any changes 
     to the ACA. I need your help. I want and need to stay alive 
     and raise my children.

  Healthcare reform allows Amy to stay on her husband's insurance plan 
and pay for the cancer treatments that are keeping her alive. The 
Republican plan would put people with preexisting conditions like 
cancer at the mercy of health insurance companies.
  Here is another way the Republican plan would hurt American families. 
Thanks to the Medicaid expansion, 650,000 people are newly covered 
under what we call the Healthy Michigan Plan. The good news is, 97 
percent of Michigan children can now go to the doctor. They don't have 
to wait and go to the emergency room. If they have a cold, their mom or 
dad can take them to a doctor. They can get preventive care, rather 
than waiting until something awful happens and going to the emergency 
room. What is the good news for the State of Michigan out of that? 
Michigan will end up, this year going into next year, with $432 million 
more in the treasury. Taxpayer dollars aren't going to have to be used 
on healthcare because the right thing was done--creating a way for 
children to see a doctor. What has happened? We have a 50-percent 
reduction on folks who don't have insurance going into the emergency 
room, and it saves money when you do that. The number of people treated 
has gone down 50 percent--the number of people treated without 
insurance.

  The great thing about healthcare to understand is that if we ignore 
it, it doesn't mean people don't get sick, that they don't get cancer, 
that they don't need a nursing home or that their child doesn't get 
sick. If you just ignore it, the costs go up because people ultimately 
use the most expensive ways to get treated.
  If you actually plan it out and do the right thing on the front end 
and people can see a doctor and they can get the checkups and the care 
they need and the treatments they need, you actually save money. That 
is the example of the State of Michigan.
  The Republican plan would end the Medicaid expansion. Healthy 
Michigan would go away. One young man in Michigan only 19 years old 
shared his story of living with his single mom when he was diagnosed 
with testicular cancer. He was working, but his employer didn't offer 
health insurance. He

[[Page S3584]]

didn't have transportation to get to his appointments or treatments.
  Thanks to Healthy Michigan, he got insurance and treatment at Munson 
Healthcare in Traverse City. He is now free from cancer, has a job with 
benefits, and is engaged to be married, and we wish him well. Healthy 
Michigan and the Medicaid expansion saved this young man's life.
  The Republican plan would end the Healthy Michigan plan, ripping 
coverage from 650,000 people in Michigan, including cancer patients. 
And for what? And for what? To pay for tax breaks for drug companies 
and the ultrawealthy one more time. This means Michigan families will 
be unable to care for their loved ones when they need it most.
  In January, I led a forum on Secretary Price's healthcare policies, 
and a woman came from Michigan to tell her story. Ann was diagnosed 
with multiple sclerosis when she was 40 years old, and she has very 
limited use of her arms and legs. We are so grateful that she made the 
trip to DC to share her story. Medicare and secondary insurance cover 
most of the cost of her medication, which costs an astonishing $75,000 
a year. That is nearly her entire household income, including Social 
Security benefits.
  Ann had been caring for her aging mom when her mom's dementia 
worsened. Ann didn't know where she would find the $6,000 a month for 
nursing home care. How many families are in that situation?
  Fortunately, Ann's mom qualified for Medicaid. By the way, three out 
of five seniors in Michigan are able to get their nursing home care 
through Medicaid. Three out of five are getting nursing home care 
because of Medicaid, including Ann's mom.
  This nursing home care paid for the final 3 years of her life. Here 
is what Ann said:

       It was only because of Medicaid that she was able to get 
     the help that she needed at the end of her life. I don't know 
     how I could have cared for my mother on top of managing my 
     own care. My family would have lost our home and all our 
     savings in trying to keep up with their bills.

  Medicaid helped Ann care for her mom at the end of her life. This is 
a good thing.
  Again, the Republican plan would cut Medicaid by $834 billion. That 
is the House plan coming over. We don't know how much would be cut 
here, but we know whatever will be cut will be used to pay for tax 
breaks for drug companies, insurance CEOs, millionaires, and 
billionaires. How does that reflect American values?
  In conclusion, Republicans are hiding their bill because they know it 
is a bad deal for American families. It is a bad deal. The President of 
the United States called it ``mean.'' I agree with him. It is mean, and 
it is definitely a bad deal for the people I represent in Michigan. 
Costs go up and care goes down, all to cut taxes for millionaires and 
billionaires. We are better than this as a country. Our Nation is 
better than this.
  It is time for Republicans to show us the bill so we can work on it 
together. Give us a chance. Give the American people a chance to have 
input, to say what they think before it is forced on them in a secret 
process that is rammed through this floor. It is time to move beyond 
partisanship to get something done for the American people.
  Again, I know that the 48 Democratic Senators in this Chamber want to 
work on lowering the cost of prescription drugs, reducing out-of-pocket 
costs, helping small businesses that want to provide coverage for their 
employees, and making the healthcare system better.
  Let's stop this bad bill and work together on behalf of the American 
people.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. MARKEY. Mr. President, when a Pope dies, the cardinals meet in 
secret to select the next Pope. A white cloud goes up in smoke. When 
the Senate Republicans meet in secret to craft a healthcare bill, 
coverage for the sick, the disabled, and the elderly is what goes up in 
smoke--all of that coverage. The only thing more secret than the 
Republican healthcare bill is Donald Trump's tax returns.
  We might need ultimately to have a special counsel to go and to find 
out what is inside of that healthcare bill because right now the 
Democrats don't know, the American public doesn't know, and no one 
knows what is in that bill. While we may not have details on the 
Republicans' secretive proposal to repeal and replace the Affordable 
Care Act, we know that they are not completely rewriting the House-
passed legislation that eviscerates the Medicaid Program and reduces 
coverage and increases costs for most Americans and for the 
individuals, the families, and the communities caught in an opioid 
crisis. This bill will be a complete calamity, and it is being done 
totally in secret.
  Right now, the press is being stifled. The White House didn't even 
let reporters audiotape the press briefing today. Last week, the Senate 
Republicans tried to keep the press from asking questions of Senators 
in the hall. They don't want the press to know about this bill or to 
cover it.
  But for families who need treatment for opioids, the Republicans want 
to take the money from substance use disorder coverage and care and use 
it to offset a $5.5 trillion tax cut for the healthy wealthy and for 
massive corporations. That would be cruel. It would be immoral. It 
would be inhumane. Like President Trump himself has said, it would be 
``mean.''
  We know the opioid epidemic knows no demographic, economic, or 
political boundaries. It has ruined the lives of men and women from 
Lexington, MA, to Lexington, KY. It is an equal opportunity destroyer. 
That is one of the reasons why, over the last year, combating the 
opioid epidemic has been a bipartisan issue.
  Eleven months ago, this body passed and sent to the President's desk 
the Comprehensive Addiction and Recovery Act. Known as CARA, this 
bipartisan law strengthens the States' responses to the opioid crisis, 
and it passed the Senate 92 to 2.
  Six months ago, the Senate passed the 21st Century Cures Act 94 to 5. 
This bill quickly became law and allocated $1 billion to States to 
provide much needed resources to help them address the opioid epidemic 
on the ground and in their communities.
  Yet today Senate Republicans are singlehandedly attempting to betray 
that progress and to erase it from the history books. They are doing so 
by crafting in secret a bill to gut Medicaid and repeal the Affordable 
Care Act and replace it with a shell that hides a massive tax break for 
the wealthiest people in our country--people who do not need or deserve 
a tax break, especially if it is coming from the healthcare coverage of 
those people who are sickest, those people who are oldest, those people 
who are most disabled, those people who are most vulnerable to having 
an addiction to opioids and need treatment. It would be wrong to take 
their money for that healthcare coverage and give it as a tax break to 
the wealthiest billionaires in America, who already have enough money 
for their healthcare coverage.
  This would be a death sentence to the 2.8 million Americans with 
substance use disorders, including 220,000 with an opioid use disorder 
at risk of losing their insurance coverage altogether in order to 
ensure that their family member can get treatment.
  For those who do manage to get insurance coverage, TrumpCare will 
make it more expensive to get the treatment and the care they need. The 
Congressional Budget Office explicitly said that out-of-pocket spending 
on mental health and substance abuse services could increase by 
thousands of dollars per individual in any one given year. For a 
disease as critical as an opioid use disorder, any delay in treatment 
can be the difference between life and death, not to mention that, 
because TrumpCare reduces protections for people with preexisting 
conditions, even those with insurance may find out that the coverage 
they have won't work for them when they need it the most. Under the 
Republican proposal, a substance use disorder could be classified as a 
preexisting condition and, therefore, you couldn't get coverage for it.
  The Congressional Budget Office also said that TrumpCare would slash 
Medicaid by $834 billion, permanently decapitating Medicaid. They say 
they are moving to a per capita system. Another way of saying that, if 
you are an

[[Page S3585]]

ordinary person, is decapitation of Medicaid for the families across 
our country who need it.
  If this becomes law, there is no Narcan for Medicaid. Once it is cut 
by TrumpCare, it is dead.
  Those devastating cuts would grind the progress we have made in 
expanding access to opioid treatment to a screeching halt and kick 
people currently in treatment to the curb. Medicaid spent $7 billion on 
substance use disorder treatment alone in 2014. That money facilitated 
access to care, access to recovery, and access to hope for millions of 
Americans. Medicaid can cover in-patient detox treatment, care 
coordination, access to naloxone.
  Additionally, Medicaid pays for one-third of the medication-assisted 
treatments in the country, more than any other payer. In Massachusetts, 
Medicaid pays for nearly one-half of the medication-assisted treatment 
provided in the Commonwealth. So think about that. One half of the 
people who get medication-assisted treatment for opioid addiction will 
lose their coverage, and, then, the Republicans are going to take the 
money they save and give it to the wealthiest people in our country, 
who also need the same coverage, leaving them with the money needed for 
those who are the one-half who won't have it. What happens to those 
other individuals? It could be a death sentence without treatment.
  Those of us from States hardest hit by the opioid epidemic hear time 
and again how Medicaid coverage of those services saves lives.
  Dawn from Swansea, MA, shared the story of her son, who became 
addicted to opioids after experimenting with prescription pain pills 
from a family member. Through Medicaid, he was able to access 
medication-assisted treatment to help treat his substance use disorder. 
Dawn said:

       He has done very well with his recovery so far but I fear 
     that without insurance coverage that will allow him to 
     continue obtaining his medication and counseling . . . he may 
     lose all that he has gained and fall back into the cycle of 
     addiction. His medical insurance is literally his lifeline. 
     Please don't abandon my son and others like him who need 
     Medicaid assistance to continue their fight against 
     addiction.

  Instead of recognizing the importance of Medicaid for families like 
Dawn's across the country, Republicans are proposing to starve this 
lifesaving program from Federal funding through TrumpCare by cutting 
more than a quarter of its budget. Because that is not enough to fund 
the massive tax breaks that Republicans want for their donor friends, 
President Trump has proposed in his budget to cut the program by an 
additional $600 billion, leaving Medicaid a shell of its former self.
  Although Republicans refer to the changes as capping the Medicaid 
Program, for Dawn's son, what that really means is they will decapitate 
his access to medication-assisted treatment, decapitate his ability to 
seek counseling, and decapitate the peace of mind Dawn receives in 
knowing her son is accessing the help he needs.
  We also have to consider the Affordable Care Act's Prevention and 
Public Health Fund and its role in the opioid epidemic. It is the 
Federal Government's single largest investment in prevention.
  Since 2010, Massachusetts has received more than $95 million through 
the prevention fund. Importantly for Massachusetts, nearly $4.5 million 
has been given to the preventive health services block grant that has 
helped the State respond to the heroin, prescription drug, and fentanyl 
drug crisis. Eliminating this fund will only hurt our ability to 
respond to the opioid and other drug epidemics popping up in every one 
of our communities.
  We should not be building bridges to recovery with money that is 
stolen from those programs in order to be spent on a wall that is going 
to pretend to block the drugs from coming in from overseas. We should 
be building bridges to recovery, not walls to isolation.
  Instead of more commissions, we need more commitments from the 
administration and congressional Republicans to not undo the progress 
we have made in preventing and treating substance abuse disorder. It is 
unfortunate that Republicans who touted our progress on opioid issues 
aren't standing up to the policies in TrumpCare that would negate their 
hard work. By supporting this, they are betraying the families and 
communities who have suffered from the relentless grip of substance use 
disorders. When discussing the opioid crisis, the only thing the GOP 
stands for right now is Gutting Overdose Prevention. That is the new 
GOP--Gutting Overdose Prevention.
  While devastating, this isn't surprising for those of us who have 
been watching many congressional Republicans salivate over ways to 
annihilate Medicaid for decades. Republicans harbor an ancient 
animosity toward Medicaid. Raiding the Medicaid coffers achieves two of 
their goals: First, it kills a lifeline for more than 70 million low-
income and working-class Americans. Second, it provides the GOP a 
piggybank to aid their donors and pay for these tax breaks for their 
friends. In fact, TrumpCare alone would provide the wealthiest 
individuals and national corporations with over $660 billion in tax 
breaks over 10 years. Included in this figure is the repeal of the 
health insurance tax, which gives a $145 billion tax break to insurance 
conglomerations and their CEOs. Millionaires will get a tax break of 
$50,000 a year--more than three times the income of most Medicaid 
beneficiaries--and the top 400 highest income earners would save $7 
million in taxes annually. All of this comes at the expense of the 23 
million Americans who will lose health insurance coverage under 
TrumpCare.
  Don't let the GOP fool you--TrumpCare is not about creating health, 
it is about concentrating wealth in the hands of a small number of 
Americans. It is about making middle-class and working Americans pay 
for a tax break for people who need it least.
  We can do better than this. We owe it to the families of the 33,000 
Americans who died from an opioid overdose last year. The proposals 
under consideration with Republicans is going to only add to the tally 
of overdose deaths. We are hearing that Senate Republicans could create 
an opioid fund as a paltry attempt to appease those who have called out 
the cruelties in this bill. That extra funding would be crumbs. It 
would be like trading a full-body cast for a bandaid, like trading land 
for a couple of beads, like trading a Cadillac for a tricycle.
  We will not be fooled. We know it took Republicans more than 1 year 
to agree to providing the funding for emergency opioid response in the 
CURES bill. One can only imagine how long it will take to get any money 
the Republicans are promoting as a consolation prize out to the 
communities who need it. We know that a vote for TrumpCare is a vote to 
perpetuate overdose deaths. Passing this bill will be just aiding and 
abetting one of public health's most wanted and most notorious serial 
killers.
  Americans from both political parties are not fooled by President 
Trump's tax cut shell game on the backs of families and communities who 
have been ravaged by opioids. That is why Democrats will continue to be 
a public megaphone and shout from the rooftops that eviscerating 
Medicaid to give a tax cut to the healthy and wealthy is mean, 
inhumane, and immoral, and we are not going to stand for it, and the 
American people are not going to stand for it.
  The best vote I ever cast in my political career of 41 years in 
Congress was for the Affordable Care Act. The second best vote I will 
ever cast is to block the repeal of the Affordable Care Act because of 
the good it has done for tens of millions of families in our country 
who otherwise would not have the coverage they need.
  Mr. President, I yield back the remainder of my time.
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Mr. President, let me thank the Senator from 
Massachusetts for his very cogent and important remarks.
  Let me just start off by asking the Chair, asking the leader of the 
Republican party, what are you afraid of? What are you afraid of? 
Health care constitutes one-sixth of the American economy. It impacts 
every man, woman, and child in our Nation. Yet we have 13 Republicans, 
all men, working behind closed doors to produce legislation that will 
be brought to the Senate at the last moment so the American people 
don't know the disaster that it is.

[[Page S3586]]

  You know, what politics is about or should be about is, if you are 
proud of what you do, you tell the world about it. You explain to the 
American people and to your constituents why this is what you are 
proposing, this is how you voted, and this is why it is good for the 
people in your State and your country.
  It should tell every American--whether you are a Democrat, a 
Republican, or an Independent, whether you are conservative or 
progressive, it should tell you something that major legislation is 
being written at this moment and that most Republicans don't have a 
clue as to what is in that legislation, let alone the Democrats, let 
alone average Americans.
  So I say to the Republican leadership, what are you afraid of? Bring 
out that bill.
  I am a member of the Health, Education, Labor, and Pensions 
Committee, the HELP Committee. The HELP Committee is supposed to be the 
committee that deals with health issues.
  I see Senator Murray is here, the ranking member of that committee. 
She will concur with me that the HELP Committee has held zero hearings.
  It is the HELP Committee. We have had not one hearing to ask members 
of the administration, people throughout this country, what the impact 
of this legislation will be on the children, on the elderly, on working 
families, on those who have chronic diseases, on ordinary Americans. 
What impact will this legislation have on the lives of 300-plus million 
people? We have not had one hearing, not one open discussion. I would 
think that every Republican would be embarrassed by this. I know many 
of them are embarrassed by it.
  So before there is any vote on any health care legislation, we need 
to have a series of hearings to discuss the implications of what the 
legislation is about.
  Mr. President, as I think you heard during the debate on the 
Affordable Care Act--and I am a member of that committee, and we had 47 
bipartisan hearings, not only in the Health, Education, Labor, and 
Pensions Committee but also in the Finance Committee and other 
committees. There were roundtables and there were walkthroughs of the 
Affordable Care Act. There was consideration of more than 300 
amendments. Some 150 amendments offered by Republicans were accepted.
  In 2009 and 2010, the Finance Committee held 53 hearings, meetings, 
negotiations, and walkthroughs on the Affordable Care Act. That 
committee marked up the Affordable Care Act for 8 days. A markup means 
you accept amendments and you have debates on amendments. That was the 
longest markup in 22 years, and adopted during that process were over 
10 Republican amendments.
  When the bill was considered on the Senate floor, the Senate spent 25 
consecutive days in session on health reform--the second longest 
session in history. Oddly enough and interestingly enough, many of my 
Republican colleagues, during that process--after 25 consecutive days 
on the Senate floor and after numerous hearings in the HELP Committee 
and in the Finance Committee, there were Senators who said that wasn't 
enough time. They said: This is such an important piece of legislation, 
and it is going to impact so many people. We need even more time.
  Senator Enzi said that ``cutting off Senate debate and deliberation 
with a budget reconciliation process would shortchange legislation with 
enormous impact.''
  Senator Lamar Alexander said:

       I don't think people are going to feel as good about a bill 
     that restructures one-sixth of our economy, that affects 
     every single American's health, and the healthcare bill is 
     being written behind closed doors in the Democratic leader's 
     office.

  In other words, you had Republican leaders thinking that the hundreds 
and hundreds of hours of discussion and debate on the Affordable Care 
Act was not enough. I find it amazing that those same Republicans seem 
to think it is OK for legislation to be written behind closed doors and 
not have one single committee hearing.
  Now the truth is, I can understand why Republicans do not want open 
discussion and open debate on this issue--because the bill they are 
working on, which is based on the disastrous bill passed in the House 
last month, is a bill that would do incalculable harm to people all 
over our country and really should not be considered as a healthcare 
bill.
  How do you talk about a so-called healthcare bill when you are 
throwing 23 million people off of health insurance? When we talk about 
a healthcare bill, the assumption is that we are improving healthcare 
in America, not doing what the Republican House bill does--wants to 
throw 23 million Americans off of health insurance. Surely that is not 
improving healthcare for the American people.
  Cutting Medicaid by over $800 billion--and God only knows what the 
implication of that will be for the children, for the elderly, for 
people who are in nursing homes.
  You are not improving healthcare when you defund Planned Parenthood. 
After all the rhetoric about choice, choice, choice--we want the 
American people to be able to go to their provider of choice--oh, 2.5 
million women who today get their healthcare through Planned 
Parenthood, I guess their choice doesn't matter.
  We hear about the needs of working-class people. We had the candidate 
Donald Trump who talked about the needs of working-class people. The 
House Republican bill--and we think the Senate bill will be very close 
to it--substantially raises premiums for older workers. That is why, 
among other groups opposing the House bill, the AARP made the point 
that this would be a disaster for older workers.
  The truth is, this is not a healthcare bill; this is a tax break for 
the rich and multinational corporations bill. This is a bill that would 
provide over $200 billion in tax breaks to the top 2 percent. This is a 
bill that would provide hundreds of billions of dollars in tax breaks 
to the drug companies and the insurance companies. Last information I 
received, the pharmaceutical corporations, the major drug companies, 
made over $50 billion in profit, but this legislation would throw 
Americans off of health insurance to give drug companies even more 
profit.
  This legislation, the House bill--and, I think, similarly, the bill 
being worked on behind closed doors--is not only opposed by the AARP, 
which is the largest seniors group in America, but it is opposed by the 
American Cancer Society, the American Heart Association, the American 
Lung Association, the Cystic Fibrosis Foundation, the March of Dimes, 
the National Multiple Sclerosis Society, and the American Medical 
Association because the doctors know what a disaster this will be for 
healthcare for millions of Americans--also, by the American Nurses 
Association and the American Hospital Association. You have all of 
these groups that are the pillars of healthcare in America saying: No, 
no, this is a disastrous bill. Yet we have the Republican leadership 
and a dozen or so Members who are working behind closed doors.
  Nobody here has suggested that the Affordable Care Act should not be 
improved. In my view, it should be improved. In my view, deductibles 
are too high, copayments are too high, and premiums are too high. 
Certainly, the fact that we are paying twice as much as any other 
country for prescription drugs has to be dealt with also.
  The task right now, among sensible people, is to put it on the table 
and to be honest about it. What are the problems of the Affordable Care 
Act? How do we lower deductibles? How do we lower copayments? How do we 
control the escalating cost of healthcare?
  Those are reasonable questions that honest people should debate, but 
the answer is not to throw 23 million Americans off of health 
insurance. That is not a solution to the problem. That is an insult to 
the American people.
  Let me just conclude by stating this. Our job right now is to make 
sure that this disastrous Republican proposal never sees the light of 
day. I would urge my Democratic colleagues, on behalf of the American 
people--the vast majority of whom know how bad this legislation is--to 
stand up and fight in an unprecedented way to make sure that that 
legislation never sees the light of day.
  After we win that struggle, I would hope that we would come forward 
as a nation and join every other major country on Earth, whether it is 
Canada--and I live 50 miles away from the

[[Page S3587]]

Canadian border--the United Kingdom, France, or Germany--and say that 
healthcare is a right of all people, not a privilege. If you are an 
American, you are entitled to healthcare. You should not be one of the 
23 million people thrown off of healthcare, bringing the total of 
uninsured in America to over 50 million people. That is outrageous.
  I think you are going to hear the American people stand up loudly and 
clearly and demand transparency and demand serious debate on an issue 
of this consequence. I think, at the end of the day, this legislation 
will be defeated.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, Democrats come to the floor this evening 
as a voice for the people we represent, to fight back against 
Republican plans to jam TrumpCare through this Senate, increase 
healthcare costs, and hurt families across the country. Republican 
leaders may hope that nobody pays attention. They can hope that they 
can go into these secret rooms and cut secret deals and come out with a 
TrumpCare bill that they can jam through before anybody notices.
  We are not going to allow that to happen. We are here. We are going 
to fight back. I can only hope that just a few Republicans will decide 
to listen to their constituents, reverse course, and work with us to 
improve healthcare instead of standing with President Trump to destroy 
it.
  I start by talking about a constituent of mine whose story I heard 
and whose voice and perspective should be a part of this debate.
  Her name is Lisa. She is from Spokane, which is in my home State of 
Washington. Lisa served our country in the Navy for 6 years. She goes 
to school. She works part time, and she says she relies on Medicaid to 
afford the healthcare she needs. She is very worried that, if TrumpCare 
passes, she will not only suffer from cuts to Medicaid, but she will 
lose her coverage altogether because, like many Americans, she has a 
preexisting condition--asthma.
  Lisa is not alone. There are millions of people just like her in 
Washington State and across this country, and each of them--every 
patient, every family--has a stake in this fight. They deserve to be a 
part of this debate, and they have a right to know how TrumpCare would 
impact them if it is signed into law.
  That should not be a partisan sentiment. I have heard Republicans 
come to the floor time and again, demanding transparency, railing 
against secrecy, calling for hearings. One Republican Senator who is 
now the chairman of the Senate HELP Committee came here to the Senate 
floor back in 2009 to blast Democrats for writing an amendment ``in 
secret.'' He said: ``None of us on the Republican side knew what was in 
it,'' and he accused Democrats of trying to pass our bill ``before the 
American people find out what's in it.''
  My friend, the chairman of the HELP Committee, is certainly not 
alone. Back then, the current Republican majority leader said: ``This 
massive piece of legislation that seeks to restructure one-sixth of our 
economy is being written behind closed doors, without input from 
anyone, in an effort to jam it past not only the Senate but the 
American people.''
  That was not true back then. We held dozens of bipartisan hearings 
and meetings over months and months and months. But it is what 
Republicans are doing right now.
  The chairman of the Senate HELP Committee, whom I respect and would 
never think would be a part of an effort like this, told me that he was 
not planning to hold a single hearing on TrumpCare. The chairman of the 
Senate Finance Committee, which is where a lot of work on this bill 
should be getting done, told my friend the Senator from Missouri that 
he was not going to hold a hearing either.
  There are reports now that Republicans actually have the text of 
their bill--something is written and almost ready. Democrats do not get 
to see that bill. People across the country are being kept in the dark. 
Republican leaders are treating it like President Trump's tax returns 
and are not allowing it to see the light of day. It is absurd, and it 
is unprecedented.
  We could be just days away from a massive bill being jammed through 
this Senate, and many Republican Senators are telling press and 
constituents that they could not even say what was in the bill if they 
wanted to because they have not seen it either. This bill is so secret 
that even President Trump's top health adviser, the Secretary of Health 
and Human Services, told us in a hearing last week that he has not seen 
how TrumpCare is being changed in the back rooms of the Senate.
  Let me ask this. Why are Republican leaders so focused on keeping 
their TrumpCare work secret? Why are they keeping it locked down so 
tight and not letting people see what is even in it? What are they so 
ashamed of?
  One Republican Senate aide was quoted as saying: ``We aren't 
stupid.'' In other words, Republicans know it would be ``stupid'' to 
put this bill in the public because they know that people across the 
country--the people they are supposed to represent--would hate it.
  That explains a lot.
  Republican leaders--those who are writing this TrumpCare bill in 
secret--know that they would not be able to go back home and defend it. 
They know that the more people who learn about what is actually in it 
and what the fine print might mean for them and their families the more 
people back home are going to rise up and fight back. So they want to 
keep it wrapped up tight, under lock and key--no hearings, no scrutiny, 
no public input. When they first announced their secret working group, 
not even any women were in it. Republican leaders are in their back 
rooms, desperately trying to cut those final deals, doing whatever they 
can to bully those last few Republicans into supporting something they 
know their constituents will hate.
  We are here tonight to say that enough is enough. This has to end. 
Healthcare is too important, and TrumpCare would be too devastating to 
allow this kind of secrecy to continue.
  We do not know exactly what is in the TrumpCare bill that is being 
written in secret, but--do you know what?--we have a pretty good idea. 
No matter how much lipstick they put on this pig, based on everything 
we have heard, this is going the same way that TrumpCare went in the 
House, and the impact on patients and families would be just as bad. 
There would be higher costs for families, especially seniors and people 
with preexisting conditions. Insurance companies would no longer be 
required to cover basic healthcare--things like maternity care or 
mental health services, and much more. Women would lose access to see 
their doctors and the care they need at Planned Parenthood, and 
millions of people across the country would see their Medicaid coverage 
taken away.
  That means that, nationwide, people who are finally getting treatment 
for substance use disorders, like opioid addiction, or mental 
healthcare or access to a primary care doctor under Medicaid are going 
to lose that access.
  This would be so devastating for families across the country. Over 
the past year, I have had so many families in my home State who have 
lost a loved one to the opioid crisis. In Bellingham, in Spokane--in 
community after community--the story is always the same. I have heard 
directly from people on the path to recovery, like Tyler in Yakima and 
Mechele in the Tri-Cities, who told me how getting treatment changed 
their lives for the better.
  I could not imagine that any Senator would want to go home, look in 
his constituents' eyes, and tell them that he helped pass a bill that 
would take away the tools that those communities need to fight this 
crisis, but that is what my Republican colleagues are planning to do as 
we speak.
  Let's remember that all of this damage would be done--why?--to give a 
massive tax break to special interests in the health industry and to 
hand President Trump a hollow political win. It is truly shameful and 
it needs to stop.
  Last week, we learned that President Trump is now saying that the 
House bill is ``mean.'' That is, certainly, an understatement from a 
President who does not often do subtlety, and it is pretty surprising 
to hear after we all saw him celebrate the House bill at the White 
House when it passed.
  Here is the truth: The House TrumpCare bill is not just mean; it is

[[Page S3588]]

devastating. The Senate TrumpCare bill is going to be just as bad, no 
matter how they try to spin it or how many side deals they cut to claim 
it has changed.
  I have a message for Senate Republicans who are so ashamed of what is 
in this bill that they are keeping it secret: It is not too late to 
change course. It is not too late to bring this process out from the 
shadows. It is not too late to be honest with people across the country 
about what you are doing. It is not too late to listen to the voices of 
people like Lisa. It is not too late to abandon this plan to jam 
TrumpCare through Congress. If you do that, if you stop, Democrats 
stand ready, as we always have, to work with you to actually make 
healthcare more affordable and accessible for patients and families 
across the country.
  People across the country are watching. They are paying attention to 
this. They are not going to allow Republicans to slip this through 
without any scrutiny, and we Democrats are here to say, loud and clear, 
that we are going to keep fighting to make sure they have a voice.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. BLUMENTHAL. Mr. President, I am proud to join my colleagues 
tonight because this Nation stands at a precipice--on the verge of a 
tragic mistake, about to embark on a travesty that mocks the democratic 
process. Truly, the combination of secrecy and speed are a toxic recipe 
in our democracy. Secrecy and speed will bring us recklessly over the 
edge of that precipice to tragic mistakes that belie and betray the 
people of America and the values that we all share in this Chamber, 
because they are basic to the American way of life.
  Healthcare is a right, and it should be recognized as a right. The 
goal of extensive and comprehensive insurance coverage has to be, 
ultimately, a goal that we share in common, but, right now, we are 
speeding secretly toward a betrayal of American values and even of our 
constitutional duties. I am deeply disappointed that the secrecy 
employed by my colleagues has brought us, recklessly and reprehensibly, 
to the verge of gutting the Affordable Care Act.
  The absence of hearings before the committee, the absence of public 
debate, the absence of any text of a bill that can be debated and 
offered for public comment leaves us without the democratic bedrock 
principle of listening to the people of America and listening to the 
people who are most affected, who know the most--the experts and the 
patients. In fact, it is the patients who deserve to be heard here 
perhaps most of all. Yet my colleagues on the other side of the aisle 
seemingly will go to any length to suppress the cruelty that lies in 
their alleged healthcare bill. President Trump has called it mean, and 
that is an understatement. It is cruel beyond words and costly in lives 
and in dollars and cents because it will deepen and worsen healthcare 
issues that can be prevented and made curable or more palatable.

  Let's be clear. This secrecy--a small group of men making decisions 
about our entire healthcare system, with no input from women, from 
Medicaid beneficiaries, from people with substance use disorders, from 
patients struggling with mental health illness, or struggling with any 
disease at all--is irresponsible and deadly and truly cruel and costly 
to our democracy.
  The way these discussions have been done are a stain on this body and 
a slap in the face to every American who relies on us to make decisions 
that are in the best interests of their family as well as themselves. 
My colleagues seemingly would prefer to ram and rush a deeply flawed 
and unpopular bill through this body, ignoring the needs and will of 
the people they represent. That is a sad day in this Chamber.
  We need public hearings, not for their own sake, not for our sake but 
for the individual recovering from substance use disorder thanks to 
Medicaid; for the mother of a little girl with a preexisting condition, 
terrified of how she will pay for her care and able to do so now 
because of the Affordable Care Act; for the woman who is at a Planned 
Parenthood clinic today receiving a mammogram and other cancer 
screenings and other preventive healthcare testing, as well as men, 
because of the coverage provided to them by Medicaid and the Affordable 
Care Act. Defunding Planned Parenthood, risking, again, preexisting 
conditions, eliminating the guarantee of essential health benefits, 
such as maternity care, is a war on women's healthcare and a disservice 
to our democracy done in secrecy.
  My colleagues across the aisle may succeed in gutting our Nation's 
healthcare system, but the people who pay the highest price will be 
ordinary Americans, working men and women and their families who now 
have healthcare coverage to prevent more serious illness and who will 
now go without it.
  Secrecy is the reason I convened an emergency field hearing on 
healthcare today in Connecticut, on very short notice--literally 24, 48 
hours--and people came from across Connecticut at 9 a.m. on a Monday 
morning. My staff did yeoman's work putting together the logistics. The 
outpouring of anxiety and anger was remarkable, as was the eloquence 
and power of the insights offered by people about their own situations 
as well as about others whose interests they advocate. Many decided to 
stay and stand, even though the room afforded inadequate numbers of 
seats for everyone. It was standing room only, and they literally 
streamed out the door. The stories they told are worth hearing, and we 
have an obligation to listen to these Americans.
  I told them I would personally bring their voices and their faces to 
this Chamber, to the floor of the U.S. Senate. In the coming days, that 
is exactly what I will do because people need to hear the story of a 
beautiful young woman who now is incapacitated because she suffered 
from an overdose after seeking treatment, and the effect on others 
similarly seeking treatment will be so dire and damaging if coverage 
for addiction treatment and abuse treatment is eliminated.
  They need to hear the story of Sean, who similarly sought to overcome 
a substance abuse problem. They need to hear about individuals who 
would suffer from preexisting conditions. Those stories are what I will 
be recounting in the coming days, as I share word for word their fears, 
their anxiety and apprehension, and their worry for America about what 
will happen if the Affordable Care Act is repealed and gutted.
  We must build on that act. We must improve its defects and make sure 
it is worthy of the great goals we share but not destroy it or decimate 
it, and building on it, acting constructively, coming together is what 
we owe the American people.
  The folks who came today to the State capitol in Hartford at my 
emergency healthcare hearing recognized that if they fail to stand up 
for Planned Parenthood or mental health or those people with 
preexisting conditions or Medicaid or their loved one who is battling a 
dreadful disease, no one will.
  I am so proud of them and the people of Connecticut who have spoken 
up and stood up for the Affordable Care Act, and I am proud to bring 
their voices to the U.S. Senate--literally bring their voices here, as 
I will do over the coming days, as I read into the Record and put in 
the Record their testimony. I will hold a second hearing, probably 
later this week, because we couldn't hear from everyone who came to 
speak out and stand up.
  I hope my Republican colleagues will stop their denial, cease 
ignoring and disregarding those voices, and come to listen to them 
instead and recognize they cannot conceal the fact that the Affordable 
Care Act has helped our Nation's health.
  Gutting it without any hearings or public debate is unconscionable 
and reprehensible. It is a move they will regret. I stand ready to 
build on the great strides made by the Affordable Care Act, and I hope 
my colleagues are ready to do the same.
  If this Chamber proceeds down this reckless and reprehensible path of 
secrecy and speed toward repeal and gutting the Affordable Care Act, I 
promise to do everything in my power and use every tool at our disposal 
to stop this process. We cannot go about normal business in the U.S. 
Senate while so many back in our States demand that we fight, and we 
must fight.
  I will stand with hundreds of thousands in Connecticut who will lose 
their insurance--more than 220,000. I

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will stand with the people of Connecticut who will lose billions of 
dollars in investment in healthcare. I will stand with more than 20,000 
people in Connecticut and 1 million around the country who will lose 
jobs. According to a study recently done by the Commonwealth Fund, job 
losses are inevitably the result, at some point in the future, of 
gutting this program. I will stand with the people of America and my 
colleagues who will resist--indeed, resist--this secrecy and speed that 
so disserves the values and betrays the ethos and traditions of this 
body.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Washington.
  Ms. CANTWELL. Mr. President, I come to the floor tonight to join my 
colleagues to raise concern about a proposed Senate healthcare bill 
that might move through the U.S. Senate, as my colleagues are pointing 
out, without a hearing, without attention to details, actually almost 
in secret. I guess it would be secret--if we didn't know exactly what 
was in the House bill, it would be even more secret. People have said 
it is probably going to be 80 percent of what is in the House bill.
  I can tell you, I agree with President Trump. That was a mean bill. 
So if it is just 80 percent mean, I guarantee it is still going to be 
mean.
  I say that because I have been at home listening to my constituents, 
and they do not appreciate it one bit. If you are Harborview Medical 
Center and you are a public hospital and you are going to cut $627 
million out of their budget because of your cap on Medicaid and you are 
going to leave a regional hospital without resources, they are mad.
  If you are talking about children's hospitals and they see children 
who are on Medicaid and they are not going to be able to see those 
children or get coverage, they are mad.
  Just Saturday I was with veterans in Vancouver, WA. People don't 
understand, but veterans of the United States of America do not get all 
of their healthcare coverage through the VA. They get it with Medicaid 
at individual clinics for services. I have met several of these people 
in my State, and they have told me point-blank, without access to 
Medicaid, they would not get the benefits they need as veterans of our 
country.
  I think it is mean to break our promise to veterans and not give them 
access to Medicaid. I think this whole discussion is basically the fact 
that we are trying to box with these guys on a proposal. If their 
proposal is so great, they should come to the Senate floor and just--
don't even talk about the bill, talk about the principles.
  I want to know, in the Republican proposal, what ideas do you have to 
lower costs, increase the quality of care, or improve access. Those are 
the milestones by which you should be debating healthcare.
  Now, if your goal is to just cut Medicaid and cut people off Medicaid 
and cut their benefits so you can give tax breaks to the rich, OK, you 
might convince me that, yes, you have a proposal--because I think that 
is exactly what their proposal is--but if your proposal is about 
reducing costs, then come out here and debate it. Don't even tell me 
what is in the bill; just show up on the Senate floor and debate us and 
say: Here is our idea for reducing costs.
  I will tell you what my idea of reducing costs is because I wrote it 
into the Affordable Care Act and some States are doing it and it was a 
good idea. It was called give the individual who doesn't work for a big 
employer the ability to negotiate with clout and be bundled up with 
other people. That is what they did for the working poor in New York. 
So 650,000 people in New York are now on something called the Basic 
Health Program. Why? Because they didn't work for an employer that 
could negotiate a big discount for them.
  We asked, on our side of the aisle: Why would we let poor people just 
get thrown around in the market and not be able to drive a decent 
price? I call it the Costco model. So we said to them: We are going to 
let you be bundled up like the big employer is and you are going to be 
able to drive a decent price in the marketplace. That plan is giving a 
family, with $40,000 a year of income and four individuals in the 
family, a yearly annual premium of about $500 instead of $1,500 on the 
exchange.
  So that is an idea. So come out here and discuss that or, if you want 
to tell me you have figured out a way to give better quality of care, I 
would love to hear that idea. I would love for you to come out and tell 
me how you are going to deliver better quality of care because I can 
tell you there are things in this bill that are about quality of care. 
They are about improving the way that organizations deliver care so 
they are rewarded for achieving better outcomes for patients.
  The whole idea of accountable care organizations are that you put the 
patient at the center of the delivery system, and you reward them for 
doing a good job of delivering better outcomes. We have innovated. We 
have innovated in the Affordable Care Act. If you are talking about 
access, come out and tell us what proposal you have that is about 
increasing the access to healthcare. I would love to hear it because in 
the Affordable Care Act, we already did that too. We said: You know 
what. It is kind of crazy and expensive to think that everybody who 
ages, particularly in Medicaid, should spend time in a nursing home. 
Why? It is more expensive, and I don't think I have met one 
Washingtonian who told me they really wanted to go to a nursing home. 
They want to stay at home.
  So we wrote into the Affordable Care Act incentives for States to 
change the delivery system, as we have done in the State of Washington, 
and deliver affordable care to people at home in their communities. By 
gosh, actually some States--Texas, Arizona, Indiana, other States--took 
us up on it. They said: What a great idea. We want to reduce costs.

  So if that is such a great working aspect of the Affordable Care Act 
and you think it works and it increases access to care by giving people 
community-based care and reduces Medicaid costs, come out here and talk 
about it. Talk about what you want to do to put that program on 
steroids so more people in America can benefit from better access to 
care and not think they are going to spend their last days in a nursing 
home. That is what we should be debating. But we can't even see or hear 
or have a hearing about what this proposal is. Yet my colleagues can't 
even come out here and throw a concept on the table.
  But the fact that you want to affect over 1 million veterans who have 
fought for our country and you are going to cut many of them off of the 
Medicaid care they deserve to have access to--that is a broken promise. 
It is just as broken a promise as what President Trump said. President 
Trump tweeted: I was the first and only GOP candidate to state that 
there will be no cuts to Social Security, Medicare, and Medicaid. So I 
am not surprised that he calls it a mean bill. But he should also own 
up that it cuts Medicaid.
  We all have an office budget. I see my colleague from Virginia here. 
If we took our office budget and said: We are going to cut it and cap 
it, and next year it is going to be lower, and next year it is going to 
be lower, and next year--in perpetuity--that is what their idea is, it 
is to put a cap on Medicaid and cut it in perpetuity and basically cut 
it out of existence.
  I don't know why they are beating up on Medicaid, because Medicaid 
has provided great stability to so many people in our country. It has 
lifted people out of poverty, provided healthcare, stabilized 
communities, and raised the economic standard of living in many 
communities in our country.
  I received a letter from a superintendent from the Vancouver School 
District. He wrote to me about the devastating impacts that capping 
Medicaid would have on his students. He wrote:

       Our school-based Medicaid programs serve as a lifeline to 
     children who can't access critical healthcare and services 
     outside of their school.

  He goes on to say:

       Restructuring Medicaid to a per capita cap system would 
     undermine Vancouver Public Schools' ability to provide 
     America's neediest children access to vital healthcare 
     [insurance].

  So why would we do this?
  I met a veteran, Kristina, who is 46 years old and a full-time 
student. She suffers from chronic and disabling injuries and needs a 
high level of care. The care she gets from Medicaid helps her access 
the medication that manages her chronic care and keeps her going,

[[Page S3590]]

and she is working toward that degree. Why would we cut somebody like 
that--a veteran--off of Medicaid just because someone's idea over here 
is to cap and reduce Medicaid?
  These stories are from all over the country, and people are 
wondering: Why would you take this level of investment in Medicaid out 
of our entire economic system? Why would you impact our school 
districts, our regional hospitals, our veterans, our Medicaid 
population? Why would you affect a community that has a large Medicaid 
base?
  And that is the way they serve them. Our hospitals have told us: We 
have stabilized private insurance premiums because more of the 
population is covered and has access to Medicaid.
  You rip that back, and we will be back to skyrocketing costs, with 
people in the emergency room, no access to care other than that 
facility, with impacts on everybody on private insurance and on 
Medicaid. It is just not a good idea.
  So I ask my colleagues, come out here. Don't say you want a patient-
centered healthcare delivery system, because we are all for that, and 
we actually put things in the Affordable Care Act that did that and are 
working. If you want to make that claim, come out here and say what it 
is that you don't like about the patient-centered delivery system that 
we are working on promoting, and how you want to change it. If you say 
your proposal increases access to Americans, let's hear it, if it is 
about better quality. But I don't hear any of that. I just hear a 
drumbeat by some people who want to be heartless and cut people who 
have access to healthcare, people who are less fortunate in our 
society, because they want to cut Medicaid.
  The President promised he wasn't going to do that. I ask my 
colleagues to live up to that, and let's start talking about the 
substance that truly will increase access, lower costs, and give better 
care to our constituents and the people of the United States of 
America.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. KAINE. Mr. President, I also rise to talk about the healthcare of 
every American. This is critically important to every person and every 
family in this country. It is critically important to every local, 
State, and Federal budget in this country. It is also critical to the 
economic productivity of our Nation.
  In a purely partisan move, the House barely passed a bill that would 
take health insurance away from 23 million American people over the 
next 10 years, dramatically increase premiums to seniors, jeopardize 
coverage of people with preexisting conditions, and impose huge burdens 
on States.
  One of the reasons the House bill was so bad--condemned even by 
President Trump, who labeled it ``mean''--was because it flowed from a 
bad process. The House held no hearings on the final bill. There was no 
meaningful testimony from patients or healthcare providers. They did 
not accept any amendments from Democrats. They rushed the bill through 
to vote before the Congressional Budget Office could score the bill. So 
no wonder. No wonder the House bill is opposed by the American Medical 
Association, the AARP, nurses, hospitals, patient organizations, 
Democratic and Republican Governors. Yet the Senate is poised to make 
exactly the same mistake--preparing a secret bill, with no testimony, 
no public scrutiny, no opportunity for meaningful amendments, no 
opportunity for Democrats to participate.
  We have the opportunity to get this right, and we have the 
responsibility to get this right.
  There are so many problems with the House bill. As a member of the 
HELP Committee, I went on Friday to the Culpeper Free Clinic about 75 
miles from here to talk about the need for real improvement in our 
healthcare system, not a repeal that would hurt vulnerable people. At 
this clinic, which is celebrating its 25th year, I saw dedicated 
staffers and volunteers, and I talked to patients. I talked to them 
about how this organization has provided compassionate care to working 
people in this region of Northern Virginia who don't have health 
insurance.
  The fact that Virginia has refused to expand Medicaid is one of the 
reasons the need for their care is so significant. Fully 70 percent of 
the free clinic patients in Virginia would be eligible for Medicaid if 
the State would just join the 35 other States that have expanded 
Medicaid.
  What I heard at the Culpeper Free Clinic is that they are already 
bursting at the seams because we haven't expanded Medicaid.
  If there are additional cuts to Medicaid, it would overwhelm the 
ability of the 60 free clinics in Virginia to provide compassionate 
care.
  Just a few hours ago, earlier today, I went to Albemarle County near 
Charlottesville and had a roundtable session with educators, families, 
and children's advocates to highlight another key problem with the 
Republican approach. By dramatically cutting Medicaid, who is the most 
likely victim? Children. The most numerous victims of Medicaid cuts are 
children.
  In Virginia and nationally, nearly 60 percent of the recipients of 
Medicaid are kids. Yet the President, through the TrumpCare bill and 
the President's submitted budget, proposes to cut Medicaid by $1.3 
trillion over the next 10 years--$1.3 trillion over the next 10 years--
and this deeply frightens parents, educators, and kids I talked to 
today.
  I heard from parents of kids with cerebral palsy and autism, parents 
whose kids are receiving support through Medicaid to buy a wheelchair 
or get services so they can learn to adjust with autism. This will help 
them grow into adults who have a chance of living independently. These 
parents had heartbreaking stories, often telling me: I had no idea of 
the challenges of parenting a disabled child until I had one myself. 
They view Medicaid as absolutely critical to their children's 
educational and life success.
  They talked about the current shortfalls in the Medicaid funding that 
leave their kids on waiting lists for services. One mom has been on a 
waiting list for a developmental disability waiver. I asked her what 
they told her about the waiting list, and this was her quote: ``They 
have told me my child will die before he is off the waiting list.'' And 
that is under the current program, before $1.3 trillion is cut out of 
it.
  I heard from school administrators who talked about the importance of 
Medicaid funding for their programs that serve students and special ed 
teachers who are worried about the effect on their work if Medicaid is 
slashed.
  Local superintendents and school board members talked about the 
difficult challenges of funding their school budget if Medicaid funding 
is cut. They posed it as a difficult choice. If the Feds cut $1.3 
trillion out of Medicaid, do they reduce their funding for their 
students with disabilities, or do they take local funds away from other 
important programs to backstop those programs, or do they have to raise 
their own State and local taxes to make up for the Federal cuts?
  I heard from child service advocates today who would see their 
program slashed if Medicaid is cut. Here is an example. Many of them 
serve court-involved young people--not kids charged with crime but kids 
who are in court because of difficult home lives and challenging 
situations with their parents or guardian, and they are in danger of 
being pushed into the foster care system or into institutions because 
of problems at home. Medicaid pays for support services to help 
stabilize their family lives. If these services are reduced and more 
children get institutionalized, how does that help anyone? How does it 
help these kids? How does it help society? How does it help our budget? 
It is much more expensive to put a child in a group home or an 
institution than to provide a few hours of Medicaid services in their 
home once a week.
  The 60 percent of Virginia Medicaid recipients who are children and 
the parents and teachers and nurses and others who worry about them and 
help them don't see this as a partisan issue. It is fundamentally an 
issue of compassion. We will and should be judged by how we treat our 
children. Why slash funds that are used to help our kids? Is it really 
important to cut Medicaid by $1.3 trillion, hurting millions of 
children, so we can give a few adults a $900 billion tax cut?
  I am on the Budget Committee. We had a hearing recently with OMB 
Director Mulvaney, within the last 2

[[Page S3591]]

weeks. Director Mulvaney tried to reassure us in his opening statement 
that the Medicaid cuts were really about doing people a favor--about 
doing people a favor. He testified: We are no longer going to measure 
compassion by the number of programs or the number of people on 
programs like Medicaid; we are going to measure compassion by the 
number of people we get off these programs and back in charge of their 
own lives.
  I want to repeat that, from the President's chief budget official: We 
are going to measure compassion by the number of people we get off 
these programs and back in charge of their own lives. What a cruel 
thought. That reads like something a villain in a novel by Charles 
Dickens would say, but that is the philosophy of this administration 
and this effort. Will we now tell a kid who loses the wheelchair that 
is partly paid for by Medicaid ``You are now back in charge of your own 
life''? Will we tell a single mom whose child is receiving services to 
help with autism but now loses access to these services ``Guess what. 
You are back in charge of your own life''? Will we tell a teenager in a 
broken home whose Medicaid services are the only difference between 
staying in the community and being put in an institution ``Guess what. 
You are now back in charge of your own life''?
  Since Medicaid also provides funding for our parents and grandparents 
who can no longer care for themselves and have to be cared for in 
nursing homes, will we go to those seniors who lose places in nursing 
homes and say ``Guess what. Now you are back in charge of your own 
life''?
  Slashing Medicaid isn't about putting anyone back in charge of their 
own life. Medicaid enables kids to go to school and succeed. Medicaid 
enables disabled people to function well enough to go to work and pay 
taxes. Medicaid enables seniors to receive compassionate care when they 
can't care for themselves, and cutting Medicaid jeopardizes the ability 
of people to live with independence and dignity.
  No, folks, let's not kid ourselves. This is not an effort to empower 
anyone. It is about casting them aside because they are too young or 
too old or too sick or too poor, and it is about giving a tax break to 
some people with the very funds we are taking away from the most 
vulnerable members of our society.
  That is why I oppose this ``mean'' effort by the majority as a 
secretly crafted bill to repeal the ACA. We can improve healthcare if 
we work together. Let the Finance and the HELP Committees discuss any 
bill, hear from patients and providers, allow amendments and debates 
before rushing anything to a vote that would so cruelly affect the 
lives of millions and millions of people.
  With that, Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Ms. WARREN. Mr. President, I get letters and emails every day from 
families begging me not to let Republicans in Congress tear up 
healthcare in this country. People aren't writing because they find 
themselves with a lot of extra time on their hands. They are not 
writing because they are professional activists or political 
organizers. They are not writing because they like writing letters and 
emails. They are writing because they are scared. They set aside all 
the other things they need to do in their day--the sink full of dishes, 
the load of laundry, the overflowing inbox--and they steal some time to 
write these letters.
  They write these letters because they are terrified--terrified down 
to their bones that if they don't speak out, their family is going to 
lose their healthcare coverage, their children will be shut out from 
care, their elderly parents will lose the assistance they need to pay 
for nursing home care, their own insurance costs will be going up, and 
their financial security could be hanging by a thread.
  A lot of people write letters and send emails, and a lot of people 
make calls too. Every week since the Republicans started their cruel 
effort to take away healthcare from tens of millions of people in this 
country, my office has been getting phone calls from worried 
constituents.
  Last week, something changed. We went from our regular quota of calls 
about this terrible Republican healthcare bill to an avalanche of voice 
mails and phones ringing off the hook.
  Since last week, I have gotten more than a thousand phone calls from 
people who are pleading with me to do whatever I can to stop 
Republicans who are going forward with their brutal plans. People are 
literally in tears on the phone. They are scared, and they are angry. 
They are calling because they know that 13 Senate Republicans--13 men--
are locked away in a secret room, behind closed doors, writing a secret 
plan to trade their health insurance for tax cuts that will go to the 
wealthiest Americans in this country.
  The bill the Republicans are negotiating behind closed doors isn't a 
healthcare bill. It is a tax cut for billionaires bill, and it is paid 
for by cutting healthcare for tens of millions of other Americans.
  The Republican healthcare bill has $663 billion in tax cuts in it--
$663 billion in tax cuts for the richest people in this country and for 
wealthy corporations, tax cuts that would blow a giant hole in the 
American budget.
  The Republicans didn't let that slow them down. They kept their eye 
on the prize. For the Republicans, the most important thing about this 
healthcare bill is the tax cuts for the rich. They decided to cut 
Medicaid by $834 billion in the same bill so they can pay for their tax 
cuts.
  This is a straight-up trade. The Senate Republicans say that 
Americans should cut health insurance for little babies or for seniors 
in nursing homes or for people getting treatment for opioid addiction--
all so that millionaires and billionaires can get their tax cuts.
  That is not a healthcare bill. That is a statement of values. And it 
says that tax cuts for a handful of millionaires and billionaires are 
more important than healthcare for millions of hard-working Americans 
and their families. There is only one word for what the Senate 
Republicans are doing with this bill--``shameful.'' It is shameful.
  The Republicans negotiate in secret, behind closed doors. They refuse 
to let anyone see the bill. They will not tell anyone what is in it.
  Senator McCaskill asked Chairman Hatch on the Finance Committee if he 
would hold a hearing on the bill, and he said no. Senator Murray asked 
Chairman Alexander on the HELP Committee if he would hold a hearing on 
the bill, and he said no, no plans to do so--no, no hearings, no 
reviews, no public look at what the Republicans are up to.
  What is going on here? I will tell you what is going on. Senate 
Republicans don't dare let the people back home see this bill. They 
don't dare let voters see this bill. Instead, they have decided to try 
to ram this bill through with no hearings, no public discussion, and 
get it signed into law.
  They hope, once that is done, people will not see much point in 
learning about the details and holding Republicans accountable. They 
hope that if they can do a quick vote, everyone else will just give up.
  I have news for Senate Republicans. That is not going to happen. 
Senate Republicans may not want to hear from families who are worried 
about losing their insurance coverage in the middle of a battle with 
breast cancer. They may not have time for stories about premature 
babies who need Medicaid so they can get lifesaving care. And maybe 
they don't want to hear about the grandparents with Alzheimer's who 
could get kicked out of nursing homes.
  Senate Republicans may not want to hear from these people, but I have 
a message for these Senate Republicans. We don't care how long we have 
to stand up here. We don't care how many times you try to dodge the 
question about what is in your secret healthcare bill. Democrats are 
here to keep demanding that you show us this bill, and we are going to 
keep insisting that you account for its shameful contents.
  I know you would prefer to take the phone off the hook so you don't 
have to hear it ring, and I know you would like to pretend that there 
aren't families in your State who would be hurt by this bill, but I am 
going to take some time to read you a handful of the letters I have 
been receiving about exactly what is at stake in this debate about 
healthcare. These families deserve to be heard.

[[Page S3592]]

  A few months ago I received a letter from Jenny in Worthington, MA. 
She wrote to me about how she and her husband got good healthcare 
coverage through the Affordable Care Act and how Medicaid was there 
when they needed it most, when Jenny was diagnosed with breast cancer.
  A few days after President Trump's inauguration, Jenny's son Liam 
wrote a letter to the President. Liam asked President Trump not to take 
away his mother's healthcare. I don't know if President Trump ever read 
that letter, but I am going to read it right now into the Congressional 
Record.

       Dear President Trump,
       My name is Liam Barry, and I am ten years old. My mother 
     has been very ill. Thanks to the ACA, my mother has been able 
     to have the care and medication she needs. If you repeal the 
     ACA, my mother will not be able to get the care she needs. I 
     know there are millions of kids in the same situation as me. 
     Please think of them when you read this.
       Sincerely,
       Liam Barry

  Thank you for speaking out, Liam. We are fighting for your mom, and 
we are fighting for you.
  Kristine from Cambridge also wrote to me about her fight against 
cancer. She wrote:

       I ask that you and fellow Senators PLEASE fight for the 
     Affordable Care Act. I am a cancer survivor. When I was 28 
     years old, I got the news no one ever wants to hear, ``You 
     have cancer.'' Luckily, for me, I had a job that had 
     wonderful insurance, and I was able to get medication, 
     surgeries, and treatment to win the fight--and to not go 
     broke doing so.
       However, I know many young people and old people and 
     children who would not be here today if it was not for ACA. I 
     know people who are still fighting their battles with cancer. 
     They are frightened and losing hope, not because of cancer, 
     but because they don't know whether they will be able to 
     continue to get the treatments necessary to stay in the 
     fight.
       I am now 30 years old, and have my whole life in front of 
     me. Because of what [President] Trump is proposing, I am now 
     afraid that if I lose my job or if I wish to change jobs, I 
     might not be able to get the necessary coverage, because I no 
     longer qualify.
       I really didn't think this is what I would be worried about 
     two years ago after having been through 8 rounds of chemo, 20 
     rounds of radiation and surgery to clear me of this disease.
       Please, I ask that you fight for us. Fight for those who 
     are in the chemo chair right now, at this very moment, who 
     are miserable, bald and bloated. Fight for the cancer warrior 
     who is now crying with worry because she doesn't know, come a 
     month from now, if she will be able to continue to receive 
     the life-saving treatment she is entitled to!

  That is why we are here tonight. We are fighting for you, Kristine. 
We are in this fight. Thank you for speaking out about your own fight 
against cancer and for others who are currently battling cancer and 
worried about the future of their healthcare.
  I also heard from Sarah, who lives in Shrewsbury, MA, and who wrote 
to me about her concerns that the Republican healthcare bill would 
endanger coverage of birth control and access to services at Planned 
Parenthood. Sarah wrote to me this past weekend, while I was out 
dancing in the Boston Pride parade.

       As I type this you are at Boston Pride, which I would have 
     loved to be at to support my friends, but, due to my 
     endometriosis pain, here I sit.
       I am extremely concerned about the GOP plan to reduce or 
     strip away insurance coverage for birth control. As a 21-
     year-old woman suffering from endometriosis, a very common 
     disease among young women, I know firsthand that birth 
     control does more than just prevent pregnancy--in fact, for 
     many, it is the only treatment for them.
       In 10 days I will be undergoing endometriosis surgery, and 
     for the past 6 months since I've been diagnosed until the 
     surgery, birth control was the only thing enabling me to 
     stand up straight most days. Even while taking oral 
     contraceptives, there were many days I was unable to get out 
     of bed (today being one).
       I am so lucky to have access to an amazing endo specialist 
     at Brigham & Women's Hospital, and to have access to the 
     medication and surgery that I need. But every time I groan 
     about having to go to an appointment, I think about how many 
     women are suffering from the same debilitating pain, but 
     without the resources to overcome it. Many women rely on 
     Planned Parenthood not just for abortions, but to provide 
     them with the medicine that will enable them to stand up 
     straight in spite of the pain they deal with every day. 
     Endometriosis doesn't discriminate, and it cannot be cured, 
     only treated. Until endometriosis becomes a prominent focus 
     of medical research, which I feel it should be, we must 
     protect the right to be treated for it, which means 
     protecting insurance coverage of birth control, and 
     protecting Planned Parenthood.
       I know that you are a warrior for women's rights, and you 
     are the patron saint of Planned Parenthood. I know these are 
     issues you fight for, and I cannot even begin to thank you 
     enough for all you have done thus far. I hope that by adding 
     my voice and my personal story, I can fuel your fire and 
     somehow be a small part in protecting my fellow females and 
     my fellow endometriosis sufferers (1 in 10 women in the US).
       Thank you for fighting for us. Thank you from the bottom of 
     my heart.

  Sarah, thank you for writing, and thank you for fighting. We are 
going to fight to save your coverage, and next year I expect to see you 
on the parade route at Pride.
  I also heard from Dr. Hemal Sampat, who is a doctor at MGH in Boston. 
He wrote in with his personal story, and I want to read parts of his 
letter.

       I actually grew up in a low-income family myself. My 
     parents immigrated to the U.S. My mother is brilliant but 
     only had a 7th grade education because my grandfather 
     couldn't afford to send her to school. My father is college-
     educated, but struggled frequently with unemployment. My 
     older brother has multiple disabilities. He's blind and 
     brain-damaged from a stroke during childhood, epileptic, 
     intellectually disabled, and has a transplanted kidney. I am 
     fortunate enough to have been healthy my entire life.
       For most of my life, my family was on Medicaid, as well as 
     other forms of public assistance. . . . My brother, 
     additionally, due to his kidney disease, got Medicare as 
     well, but Medicaid was always his secondary insurance. He 
     sees multiple different specialists and has done very well 
     over these years.
       In spite of us having multiple financial struggles, we 
     never had to worry about his healthcare being paid for. His 
     transplant from childhood lasted 19 years, and then about 10 
     years ago he was transplanted again and has done well with 
     that.
       My parents still live in the same house I grew up in, in 
     Maryland. Right now, they're cared for by Medicare and 
     Medicaid. My brother lives with them, receives SSI, and his 
     health needs are met by Medicare and Medicaid. Although none 
     of his chronic medical conditions can be cured, they are all 
     well taken care of.
       In the meantime, I grew up healthy, was able to attend 
     Georgetown through need-based financial aid, was able to get 
     into medical school at the University of Maryland and pay for 
     it using Federal student loans (which I'm repaying through 
     the Public Service Loan Forgiveness program), got into a 
     dual-specialty residency of Internal Medicine and Pediatrics 
     at Penn State, and am now working at Harvard and MGH.
       My family's story goes to show that Medicaid is about 
     helping families that struggle, about helping children with 
     complex medical needs, and about how providing for the good 
     health of a family can achieve positive outcomes for the 
     long-term future.

  Today, Dr. Sampat works at Harvard at MGH. He makes sure his patients 
on Medicaid get excellent care. He told me about one of his patients 
who came in to urgent care in Chelsea. This little girl wasn't even 2 
years old yet and was wheezing and had a fever. Here is what the doctor 
said:

       This child and her mother were on Medicaid through 
     MassHealth. [As] I asked questions, I found out more about 
     this mother. She was working two to three jobs in order to 
     make ends meet. Her daughter was in daycare during the day 
     and then [the] grandmother took care of [the little girl] 
     most evenings. This mom took care of her daughter on the rare 
     days she had off and clearly loved and cared for her 
     daughter.
       This young girl's wheezing was probably some of the 
     earliest signs of what will become asthma. [Her] mom has 
     asthma, too, and it runs in their family. Asthma is a 
     completely controllable illness with medication, but it 
     requires monitoring by a doctor and access to medication. 
     Because the child has Medicaid, I feel much more confident 
     that, in spite of how much the mother is struggling 
     financially, the child has a good shot at growing up healthy. 
     Without Medicaid, this child could live a life in poor health 
     from a treatable condition.

  These are some of the people the Senate Republicans want to kick to 
the curb so they can deliver a big tax cut for millionaires and 
billionaires--a 10-year-old kid with a sick mom, a cancer survivor, a 
woman with endometriosis, a boy kept healthy by Medicaid so he could 
grow up to become a doctor at one of the best hospitals in this country 
and help a little girl with asthma.
  Senate Republicans are willing to tear away health insurance from 
these families to deliver tax cuts for their buddies, but we are not 
going to let that happen. We can't let that happen. You are fighting 
back, we are fighting back, and we will keep right on fighting.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Pennsylvania.
  Mr. CASEY. Mr. President, I will start tonight with one of the 
questions

[[Page S3593]]

that we have, and this will be a procedural question. I want to alert 
the Chair, I am going to pose this question initially before I make my 
remarks about the debate we are having on healthcare.
  Is the Chair able to confirm that the Committee on Finance considered 
S. 1796, the America's Healthy Future Act, which was ultimately 
incorporated into H.R. 3590, the Patient Protection and Affordable Care 
Act, in executive session on eight separate calendar days prior to 
reporting the bill favorably?
  The PRESIDING OFFICER. The Secretary of the Senate's office, through 
the Senate Library, confirms that.
  Mr. CASEY. Thank you.
  Mr. President, I rise tonight to provide some context about what is 
at stake for children in the United States with regard to the debate we 
are having on healthcare and, in particular, what would happen--some of 
the adverse impacts on children with disabilities.
  I will start with the broad view, but I think it is important to 
frame our discussions. Sometimes our debate on healthcare comes down to 
a discussion of big numbers. How many people will be impacted? For 
example, the Congressional Budget Office told us that 23 million people 
would lose their healthcare coverage over the course of a decade if the 
House bill were to become law. So healthcare coverage would be ripped 
away from 23 million people or we hear about the impact on the deficit 
one way or the other or we hear about broad numbers. Probably the best 
way to think about the impact of these policies is, if the House bill 
were to become law or some version of it because of what a few Senate 
Republicans are working on right now--maybe the better way to think 
about it is in terms of a couple of individuals, children.
  I will give you two examples for now. Angelica and Rowan--two 
different children, two different stories. We received a letter in the 
last couple--I am sorry. Angelica is the parent. I should have said 
Amaya. Amaya is the child whom her mom wrote to us about. Her mom is 
Angelica.
  She wrote to us and said:

       I am writing to you because I am appalled by all that is 
     happening to this country. I have an amazing story about my 
     daughter Amaya. She was basically born with no bones and she 
     received a miracle drug that regrew her bones. She will have 
     to take this medicine for the rest of her life but the fact 
     that she is doing so amazing has to do with all the help that 
     she received from Medicaid. She is the youngest patient in 
     the U.S. to take the drug. I don't only want to talk about 
     her but I am concerned about the future of our party. Looking 
     forward to hearing from you.

  So said Angelica. Then, later on, she talks about what happened in 
her case to her child. She says she decided with a counselor to check 
with the Allegheny County officials about whether or not Medicaid 
expansion would cover Amaya's treatment. She said they made an inquiry. 
She said by the next day, ``Someone from the State had called me, and 
later that week her treatment was approved. Thanks to the Medicaid 
expansion, my daughter receives her lifesaving treatment.''
  So I make that reference to one letter about one child, Amaya. Then, 
of course, there are so many other letters. I will just highlight one I 
received months ago now from Pam Simpson. She is from Coatesville, PA--
Southeastern Pennsylvania just outside the city of Philadelphia. Now 
you are talking about Rowan in Southeastern Pennsylvania and Amaya in 
Southwestern Pennsylvania, two corners of the State--two children 
facing challenges that most of us can't even imagine.
  In this case, Pam Simpson wrote to me about her son Rowan and talked 
about his life before a diagnosis of autism and before he was getting 
the help he is getting now. Pam talked about all of the challenges she 
and families like her face. She talked about the fact that he was 
having all kinds of difficulties, but then they finally got the word 
that Rowan would be covered by Medical Assistance. That is the 
Pennsylvania version of Medicaid at the State level. She said she 
applied in January of 2016. After Pam got the word that Rowan would be 
enrolled, she said:

       We were able to obtain wraparound services, which included 
     a behavioral specialist consultant--so-called BSC--and a 
     therapeutic staff support worker. The wraparound services 
     have been a godsend--

  Referring to the services provided to her son Rowan. Then she goes on 
later in the letter and says:

       Without Medicaid, I am confident I could not work full time 
     to support our family. We would be bankrupt or my son would 
     go without the therapies he sincerely needs.

  Here is how Pam concludes her letter:

       Please think of my dear Rowan and his happy face, his big 
     blue eyes, and his lovely strawberry blonde hair. Please 
     think of me and my husband, working every day to support our 
     family, and please think of my 9-month-old daughter Luna.

  I will stop there just to explain. She is talking about Rowan, who is 
a couple of years older. The reference here is to his younger sister 
Luna.

       Please think of my 9-month-old daughter Luna who smiles and 
     laughs at her brother daily. She will have to care for Rowan 
     later in her life when we are gone. Overall, we are 
     desperately in need of Rowan's Medical Assistance and would 
     be devastated if we lost these benefits.

  That is what Pam Simpson wrote to me months ago. After referring to 
her story and Rowan's story over the last couple of months, I finally 
had the chance to meet her and to meet Rowan and his dad and his sister 
Luna. So I met this family--four people in a family. I met them on 
Friday. It is one thing to read about it and to get a sense of what a 
family is up against every day, and it is another thing to meet them. 
Right now, the Simpson family has what they need for Rowan. That 
doesn't mean they don't have challenges. It doesn't mean it will not be 
difficult in the years ahead, but they have the benefit of Medicaid 
right now--Medical Assistance, as we call it in Pennsylvania.
  Rowan now, because he has autism, has the benefit of those behavioral 
specialists and Medical Assistance. There was a person with them the 
day I met them, to work with Rowan every day so the parents can work 
and have the peace of mind to know they can go to work, and they can 
raise their family with the benefit of the kind of healthcare every 
child should have. Some might say: You know what. If the Republicans 
get their way on this bill, maybe the Medicaid provisions will not 
apply to Rowan. Maybe he will be protected or maybe in Allegheny 
County, maybe Amaya will be protected. Maybe it will not reach that 
far. Maybe when the Congressional Budget Office--I will read directly 
from page 17 of the report by the Congressional Budget Office analyzing 
the House bill when it says: Medicaid enrollment would be lower 
throughout the coming decade, culminating in 14 million fewer Medicaid 
enrollees by 2026, a reduction of 17 percent relative to the number 
under current law. That is what the Congressional Budget Office says 
about the impact of the House bill on Medicaid--14 million people lose 
their Medicaid.
  Some might say: Let's assume for purposes of this argument that those 
two children we just spoke about might be protected from those cuts. We 
don't know that, of course, and they can't guarantee that because what 
they are doing when they go at these Medicaid provisions is taking away 
the guarantee that has been there for 50 years and, over time, 
eliminating the Medicaid expansion. That is what we expect to happen. 
That is certainly what the House bill did.

  Let's assume for the sake of argument that they could come in here 
and make an ironclad guarantee that those two children, Rowan and 
Amaya, won't be affected. You know what. That is not good enough. That 
is not good enough because there are a lot of other children who will 
be affected, children who might have a disability.
  Sixty percent of children with disabilities are enrolled in Medicaid. 
We know that. We know that millions of other children who come from 
low-income families get the benefit of Medicaid. We know that a lot of 
seniors depend upon Medicaid to get into a nursing home. But no family 
who has a child with disabilities who benefits from Medicaid should 
have to worry for 15 minutes about what would happen in this Chamber--
because a small group of Republican Senators are meeting in secret, and 
they are supposed to produce a bill that we are all supposed to 
consider in a short timeframe--no product of that secret process should 
in any way give any parent who has a

[[Page S3594]]

child with a disability any concern at all that that benefit will be 
taken away. That is not who we are as a country. We are America. We 
take care of people who need those kinds of services, that kind of 
benefit.
  So if a child like Rowan, who is receiving the benefits of Medicaid 
today because of his disability--if a child like that is receiving 
those services today, we should guarantee that he will receive those 
benefits for as long as he needs those benefits. Even if it goes the 
length and breadth of his life, we should guarantee that, take it off 
the table so that family doesn't have to worry.
  That, I hope, would be the result of this process undertaken by a 
small group of Republican Senators. I have been waiting to hear that, 
waiting to hear whether they will guarantee that to that child, to give 
that family some peace of mind with all the challenges they have, even 
with Medicaid, even with the great support they get. It is not easy. It 
is a very difficult life many families lead when they have a child with 
a disability. But we should do everything we can to make sure that if a 
child with a disability--just one category of people who benefit--any 
child with a disability who gets the benefit of Medicaid should have 
that protection for as long as they need it. And I will be waiting to 
hear that from our colleagues when they finally emerge from this 
secretive process with the bill. So I hope that is what they are 
working on in their meetings because we know that it affects a lot of 
children.
  As I said before, Medicaid covers 60 percent of all children with 
disabilities, ranging from autism, like Rowan, to traumatic brain 
injuries. We know that children on Medicaid receive what many consider 
the gold standard for children's healthcare--early and periodic 
screening, diagnostic and treatment options, so-called EPSTD--so they 
can get the screenings they need, so they can get preventive healthcare 
when they need it.
  All of these protections should be not just a goal, they should be 
guaranteed for those children. I am hoping our friends who are working 
on this right now will consider Rowan and Amaya and children like them.
  We will come back to it later. We will have other stories to tell 
about children and what they are up against. But on a night like 
tonight, I am thinking of those children and worried about some of the 
headlines we are seeing on some analysis.
  I will wrap up with this: The Center for American Progress report 
dated May of 2017 is titled ``Cuts to Medicaid Would Harm Young 
Children With Disabilities.'' That is one report. Another report is 
from the Center on Budget and Policy Priorities, May 18, 2017: 
``Medicaid Cuts in House ACA Repeal Bill Will Limit Availability of 
Home- and Community-Based Services.'' That is another headline. We 
won't get into the details of those reports now.
  We have a lot to work on here to make sure that nothing that happens 
in this process will rip away healthcare from children with 
disabilities.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Perdue). The Senator from Oregon.
  Mr. MERKELY. Mr. President, I commend my colleague from Pennsylvania, 
who is putting forth a powerful message about our values, and that is 
that every child in America should have access to healthcare, and no 
one in this Chamber should vote in a process or for a bill that 
eviscerates that coverage. In fact, our value is that no one in 
America, including our adults, including our older Americans, including 
our seniors, and including our children for sure--everyone should have 
access to affordable healthcare and never have the stress of being 
worried that if their loved one gets sick, they might not receive the 
care they need. They should never have the stress of concern that their 
family member might go bankrupt because they need medical care. It is 
that value which we are here tonight fighting for, and it is that value 
which the Republican bill will destroy, ripping healthcare away from 
millions of Americans. So we come here tonight with a battle cry, and 
that cry is: No hearing, no vote. No hearing, no vote.
  We are a democratic republic. We are a legislative Chamber. Have 
Members of this Chamber forgotten that we are a ``we the people'' form 
of government where the people are in charge? The people are not in 
charge if a secret 13 group of Senators is hiding in the basement 
crafting a bill to rip healthcare away from millions of people. The 
people are not in charge if they are afraid to show their bill to 
everyday Americans. They are not in charge if they are planning to 
destroy healthcare so those with preexisting conditions can't gain 
access to care.
  Never have we seen a group in the majority so against the fundamental 
principles of our democratic Republic, so against the ``we the people'' 
vision of our Constitution, and that is why we are calling on them to 
stop, rethink, remember, absorb the values embedded in our beautiful 
``we the people'' Constitution. They want no public disclosure--fear of 
how the public will respond. They want no committee hearings--fear of 
how the people in America will respond. They want no committee 
amendments because that will take time in which the people can see what 
is going on and respond. And they want no substantial floor 
consideration in order to shove this through so they can go and 
celebrate the Fourth of July with their constituents, while having 
eviscerated the Constitution of the United States in the process of 
attending that Fourth of July gathering.
  This has been called the vampire bill, the Republican vampire bill. 
Why? Because the writers of it, the secret 13 writers, are afraid for 
the bill to see the light of day. It is hiding in the darkness. And it 
is called the vampire bill because its general intent is to suck the 
life out of the healthcare system for struggling families, suck the 
life out of the healthcare system for working families and for middle-
class families.
  This is quite different from the consideration when we created the 
system that we have now back in 2009. In that year, in the HELP 
Committee--Health, Education, Labor, and Pensions Committee--there were 
47 hearings, roundtables, and walkthroughs, a markup that went for more 
than a month--the longest markup in that committee in the history of 
the United States of America; a markup that considered over 300 
amendments; a markup with, in fact, a group of Senators, bipartisan, 
sitting around the table with the television cameras rolling while they 
debated those amendments and voted on those amendments. And in that 
committee, they accepted or approved by vote more than 100 minority 
amendments.
  Then there is the Finance Committee, which held 53 hearings and 
roundtables. In fact, the minutes of the roundtable are available, and 
if you want to print them out and read them, they go for 800 pages--
just the roundtable minutes. And then they had their own Finance 
Committee markup, where they considered 135 amendments. Then the bill 
came to the floor in December 2009, and there was 25 days of debate on 
the floor.
  Let's compare that to the plan of the majority leader and the secret 
13. Well, how many hearings do they want? They want zero in the HELP 
Committee. How many hearings do they want in the Finance Committee? 
They want zero. How many Democratic amendments do they want to 
consider--or Republican amendments--in the HELP or Finance Committee? 
The answer is zero. How much floor time do they want to have? They want 
to have just 1 day--just 1 day. They want to introduce it as an 
amendment to the House TrumpCare bill and pass it on the same day. And 
how many days do they want experts to be able to weigh in on a 
healthcare system? Zero. But here is the most important zero of all: 
How much time do they want for the American citizens to be able to see 
this bill and respond to this bill? They want zero time. That is 
completely against all the premises of our responsibility as 
legislators. It is against all the fundamental visions of a body that 
will deliberate and debate and take into account the opinions of the 
people and the insights of the experts.
  Well, we can turn the clock back not so long ago to the majority 
leader, who said: ``Fast-tracking a major legislative overhaul such as 
healthcare reform . . . without the benefit of a full and transparent 
debate does a disservice to the American people.'' That was Majority 
Leader Mitch McConnell speaking not so long ago. What happened to that 
value? That was being said when we had 25 days of debate here

[[Page S3595]]

on the floor; when we had over 100 minority amendments--that is, 
Republican amendments--accepted; when we had a lengthy debate in the 
Finance Committee and a lengthy debate in the HELP Committee, but the 
majority leader wanted more time. Here he is today leading the effort 
to have zero input from the American public, zero input from healthcare 
experts, zero committee deliberation, zero bipartisan discussion of the 
pros and cons.
  Well, we can turn to Paul Ryan. What did he think back in 2009? He 
said: ``Congress is moving fast to rush through a health care overhaul 
that lacks a key ingredient: The full participation of you, the 
American people.''
  He went on to write: ``Congress and the White House have focused 
their public efforts on platitudes and press conferences, while the 
substance and the details have remained behind closed doors.''
  Well, it was kind of a rewriting of history even at that moment in 
time when he said that when there was a record-setting debate in the 
HELP Committee, the second longest debate in history in the Finance 
Committee, television cameras running the whole time, 100 Republican 
amendments adopted, more than 100 meetings and walkthroughs and 
roundtables and committee meetings, and 25 days on the floor. But Paul 
Ryan said that what it was lacking was full participation of you, the 
American people.
  Well, if it was lacking in 2009, what do we say about this when the 
majority deliberately wants to exclude the American people, when the 
American people are standing at the door, when they are standing at the 
windows and they are leaning in and saying: What is in this bill? We 
want to have a say because it is so important to our families.
  And the Republicans are slamming the door, and they are shuttering 
the windows and saying: We will not share one word with you because we 
know you won't like what we are doing.
  That is not the way democracy is supposed to work.
  Erin from Portland wrote because she has been diagnosed with diabetes 
and is terrified that if the Republican plan goes into effect, she 
won't be able to afford coverage because of her preexisting condition. 
Jeannette from Portland wrote. She is in her sixties and desperately 
waiting to turn 65 and qualify for Medicare. She is on the Oregon 
Health Plan and terrified that she will lose that plan before she 
qualifies for Medicare. The list goes on and on and on.
  This weekend, I was out conducting townhall meetings in 4 different 
counties of my 36 counties. I go to every county every year. And these 
four counties are counties that voted--I am sorry to say--
overwhelmingly against me when I ran for the U.S. Senate and 
overwhelmingly against me when I ran for reelection. They are red 
counties; they are Republican counties.
  Folks came out to my townhalls this weekend, and they sent one 
message to our Republican leadership in the Senate: We the American 
people demand the chance to participate in this debate. It so 
profoundly affects our quality of life.
  So I carry their messages from Klamath County and from Lake County, 
and I carry their messages from Grant County and Wheeler County to the 
Republican majority: Listen to the American people. Listen to rural 
America. Listen to the families who will be devastated by the plan you 
are concocting with the secret 13. It is not right. It is not moral. In 
fact, we need to work together to improve healthcare, not to devastate 
it.
  Thank you, Mr. President.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Ms. KLOBUCHAR. Mr. President, I rise today to join my colleagues, to 
speak out, and to ask for a normal process here and to ask for 
hearings, to ask for debate, and to ask for amendments because the 
healthcare repeal bill is a major step backward, throwing over 20 
million people off of health insurance. It is strongly opposed by AARP.
  We don't know what is being concocted here in the Senate, but clearly 
something is going on, and we would like to have a say, and, most 
importantly, the people of my State would like to have a say.
  Look at Laura from North St. Paul, who wrote to me about her concerns 
about that health bill. Laura is recently retired, but she will not be 
eligible for Medicare until next year, and she has a daughter with 
several chronic health conditions. Laura is worried that if the 
proposal goes through this Chamber, she will end up paying far more for 
her health insurance, and her daughter might lose her coverage 
altogether. Like so many others, Laura asked that we work across the 
aisle to make improvements to the bill that her family needs and that 
so many families across the country need.
  Take Mike from Grand Marais, which is in the far corner of Minnesota, 
right at the tip of our State, not too far from Canada. Mike knows the 
kind of healthcare they have across the border in Canada. He knows what 
the prices are for the prescription drugs there, but here in America 
that healthcare bill doesn't do anything to bring down the cost of 
prescription drugs.
  Mike has been self-employed his whole life and is now approaching 
retirement. He told me that he is very worried that, just as he is 
about to retire, he will not be able to afford health insurance because 
the premiums that are under that bill for older Minnesotans like him 
would skyrocket.
  Take a woman from Andover, MN. She wrote to me to say that she is so 
worried ``about the GOP's slam dunk attempt to check off a box on their 
to do list'' with the healthcare proposal. She asked me to put a face 
on the type of person that will be a part of that checklist on that to-
do list, and that would be her 28-year-old son. She says that Medicaid 
coverage has been a lifesaver for her son because it helps him afford 
the treatment he needs to strive for an independent, productive life.
  The truth of the matter is that I have heard so many people like 
these three, from all corners of my State, from the old to the young to 
the middle-aged. I have heard from so many people from the rural parts 
of my State about this bill. They are especially worried about the $834 
billion in cuts to Medicaid. Medicaid covers more than 1.2 million 
Minnesotans, including more than one-fifth of our rural population. 
That is 20 percent of our rural population. This funding is vital for 
our rural hospitals and the healthcare providers' ability in those 
parts of our State to stay open and serve their patients.
  Many people who work in rural hospitals and those who are served by 
rural hospitals have come up to me to talk about their concerns. These 
hospitals are not like big urban hospitals.
  I see the Senator from Hawaii here. I thank him for organizing this 
along with Senator Murray.
  Our rural hospitals actually treat a lot of accidents, people out 
snowmobiling or on ATVs. In fact one of them has a chart every summer 
showing all the places where they had to remove fish hooks from 
people's hands. They usually have over 100 of them by the end of the 
summer. You wouldn't see that in an urban area--that is for sure--but 
it just shows that different parts of our country, different parts of 
our State have different issues they are dealing with.
  Rural hospitals are particularly concerned about these cuts. These 
drastic cuts would cause many of our rural hospitals to close, forcing 
families to drive 60, 70, 80 miles or more when they need the 
healthcare the most.
  The other issue that this bill brings up to me, when looking at rural 
areas, is the opioid epidemic that is hitting communities across the 
country. In my State, deaths from prescription drug use now claim more 
lives than homicides or car crashes. While there is more work to do to 
combat this epidemic, I want to recognize that we have made meaningful 
progress so far in a bipartisan way. We passed the framework bill, the 
CARA bill. We passed the Cures Act last December, as well as money to 
fund treatment. Unfortunately, just as we are starting to move forward 
on this issue, the healthcare repeal bill passed by the House would put 
us at the risk of moving backward. There is money in that bill for 
opioid treatment, but guess what. Medicaid and children's health 
insurance covers 3 out of every 10 people with an opioid addiction. But 
according to the nonpartisan Congressional Budget Office, mental health 
and substance abuse benefits could be cut under the House bill, 
increasing out-of-pocket costs.

[[Page S3596]]

  It is clear that this healthcare legislation has massive life-
changing implications for families all over this country. Yet we 
haven't even seen a draft in the Senate. What we do know is that, just 
last week, the President of the United States, who is known for not 
really mincing words and known for using direct language, called the 
House bill ``mean.''
  He called it ``mean.'' He didn't need a poll or a focus group. He 
didn't need to know every detail of the bill, but when you hear that 20 
million people can lose health insurance, that is a pretty good word to 
describe it--mean. What we don't want to have in the Senate is that we 
bring forward the Senate mean, or mean 2. But guess what. We don't even 
know what we have because we haven't seen it, because the legislation 
is being drafted behind closed doors. Most of us agree that we must 
make changes to the Affordable Care Act. I certainly think so. I would 
love to pass my bills or include them in amendments to the Affordable 
Care Act to bring down the cost of prescription drugs.
  My bill would allow 41 million seniors to harness their negotiating 
power to bring drug prices down. Right now they are banned to do that. 
That is wrong.
  I would love to see more competition come into the market in the form 
of less expensive drugs from other countries, like Canada--a bill I 
have with Senator Kaine or a bill to make it easier to get generics on 
the market, like the bill Senator Grassley and I have to stop something 
that is called ``pay for delay.'' I think the American people would be 
surprised that the big pharmaceutical companies are paying their 
generic competitors to keep their products off the market. These are 
improvements to the bill.
  We can make improvements to the exchanges. Just as we have done some 
of that work in the State of Minnesota, we can do that nationally. We 
can make improvements to small business rates. Those are things we can 
do, but we cannot do it if we can't get through the door because the 
door is closed. When the door is closed, it is not just closed to the 
Democrats and Republicans in the Senate, but the door is closed to the 
American people.
  What it all comes down to is that we need to work in a bipartisan way 
to make healthcare better and less expensive for the people in our 
country. Last week, we all came together. I was at that Congressional 
Baseball Game. It was an amazing moment, with 25,000 people in the 
stands. All four leaders were out there looking like they actually 
liked each other. There they were, and there our teams were--two teams, 
a Republican team and a Democratic team. In the end it was a hard 
fought game. One team won. The Democratic team won, but do you know 
what they did with their trophy? They handed it to the Republican team, 
and they said: Put it in Representative Scalise's office.
  We want to take that spirit and go even further--instead of two 
teams, one team for America. That is the way we make the changes to an 
issue that has been long fought on both sides. I know Republicans 
weren't happy with everything that happened during the debate on the 
Affordable Care Act. They have made that clear. But now we have a 
moment in time where we could come together and make some sensible 
changes and make things better for the people of this country. Let's do 
it.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Minnesota.
  Mr. FRANKEN. Thank you, Mr. President.
  I rise today to talk about the Republican effort happening in total 
secrecy behind closed doors under the direction of Leader McConnell to 
repeal the Affordable Care Act and gut Medicaid in order to give huge 
tax breaks to the wealthiest Georgians, the wealthiest Americans.
  Just about 5 months ago, I came before this body. I issued a simple 
request to Republicans. I asked you to show me your plan to repeal and 
replace the Affordable Care Act.
  I asked you to show me the plan that was going to be ``terrific.''
  As to the bill that President Trump promised during his campaign and 
the one Republicans had 7 years to come up with, I asked you to explain 
how you would meet the standards set by one of President Trump's top 
advisers, Kelly Anne Conway, who said: ``We don't want anyone who 
currently has insurance to not have insurance.''
  I asked you all to show me the plan that retains coverage for the 
nearly 20 million people who have gained it, continues to contain 
healthcare costs, and ensures that nobody gets denied or has to pay 
more because of their gender or because of preexisting conditions.
  I never got that plan from you. Instead, what we received was the 
American Health Care Act, or the AHCA, a heartless, terrible bill that 
passed the House in early May, a bill that President Trump heralded in 
the Rose Garden, after its passage, as ``great.''
  The AHCA is a far cry from what President Trump and his allies 
promised. If the AHCA becomes law, 23 million more people would be 
uninsured. The bill ends protections for people with preexisting 
conditions and drives up healthcare costs dramatically for older, 
sicker folks. Worse still, the AHCA would end the Medicaid expansion 
and slash Medicaid by $834 billion over 10 years. For what? To offer 
massive tax breaks to the wealthiest Americans, for the wealthiest 
Georgians in the Presiding Officer's State. The average tax savings for 
the 400 richest families under this plan is $7 million apiece each 
year--$7 million each for every year, because they need it.
  No wonder people are outraged. Just 8 percent of Americans think the 
Senate should pass this bill into law unchanged. Well, 8 percent has to 
be a new low.
  Americans do not want TrumpCare. Three in four Americans want 
President Trump and his administration to do what he can to make the 
ACA work rather than undermining it.
  Even President Trump reportedly now considers the House bill to be 
``mean.'' It went from ``great'' to ``mean.'' In the Rose Garden, it 
was great. Now, a few weeks later, that same great bill is mean.
  Instead of listening to the American people, Republicans are pursuing 
a strategy that former Acting Administrator of CMS Andy Slavitt has 
described as sabotage, secrecy, and speed.
  Up first, sabotage.
  In a few years, Republicans have choked off the Risk Corridors 
Program, which was designed to help stabilize premiums in the first 
years of the new exchanges. The Trump administration has gone even 
further. It has stopped enforcing the individual mandate, has 
undermined outreach efforts to help people sign up for health 
insurance, and has cut in half the amount of time that people have to 
sign up for health insurance coverage.
  Perhaps the most troubling of all is that Republicans have refused to 
commit to funding cost-sharing reduction payments. These payments help 
low-income families cover their out-of-pocket costs. Since insurers are 
not sure if they can count on the administration to continue to provide 
these payments, some are pulling out of the individual market or are 
dramatically increasing their premiums to account for this instability, 
this uncertainty.
  There is much more we can do to shore up the individual market, but 
my colleague Senator Stabenow had it right when she said to Secretary 
Price, of the Presiding Officer's State, regarding the administration's 
sabotage efforts: ``It's like pulling the rug out from under somebody 
and going, `Oh, my gosh. They fell down.' ''
  That was from Debbie Stabenow, of Michigan.
  The next tenet of the Republican approach is secrecy.
  A group of 13 men has been meeting in secret to draft the Senate 
version of the AHCA. What little we do know is that Senator Cornyn 
estimates there will be about an 80-percent overlap between the Senate 
and House bills. Prior to now, our understanding was that the Senate 
Republicans would completely rewrite the bill, with Senator Burr even 
saying the House bill was ``dead on arrival.'' It sounds like that plan 
has been jettisoned, but we cannot be sure because the Senate has had 
precisely zero hearings, zero days of public floor debate, and we have 
yet to see or hear about the revised draft of the AHCA, despite the 
forthcoming vote.
  I urge my Republican colleagues to recall that during the long debate 
over the Affordable Care Act, the Senate held nearly 100 bipartisan 
hearings, roundtables, and walkthroughs, and had 25 consecutive days of 
public floor debate. Let me repeat that--nearly 100

[[Page S3597]]

bipartisan hearings, roundtables, and walkthroughs in the Senate alone, 
with 25 consecutive days of public floor debate on a bill that affects 
one-sixth of our economy. In the Senate HELP Committee, Senators 
considered nearly 300 amendments during a 13-day markup--one of the 
longest in congressional history--and ultimately accepted more than 160 
Republican amendments in the process.
  In 2009, then-House Budget Committee Ranking Member Paul Ryan argued:

       Before Congress changes healthcare as the American people 
     know it, we must know the likely consequences of the House 
     Democrat legislation, including the number of people who 
     would lose access to their current insurance.

  The irony is palpable. Feel the palpable irony. Do you feel it? Does 
everybody feel it?
  That brings me to the final component of the Republican approach, and 
that is speed.
  Leader McConnell would prefer to have a vote on the Senate plan 
before the July 4 recess or shortly thereafter. That timing only leaves 
us with a few days to go. There will just not be enough time to truly 
understand how this bill would affect the healthcare system, which, 
again, is one-sixth of our economy and affects all of the millions of 
Americans who rely on it.
  Republicans plan to schedule the vote in such a way as to keep the 
American people in the dark about this bill for as long as possible. 
The American people deserve a chance to weigh in on a bill that would 
affect their lives and those of their friends and families in my State 
of Minnesota and the Presiding Officer's State of Georgia.
  My office has received over 15,000 letters from very worried 
Minnesotans these past few months, and I have gone to visit rural 
healthcare facilities that would be among the hardest hit by the AHCA. 
My constituents--the people of Minnesota--are frankly scared about what 
will happen to them or their families if they lose their health 
insurance, and I am too.
  As I did in January, I would like to encourage my Republican 
colleagues to join me on a trip to Minnesota to meet Leanna. Leanna's 
3-year-old son Henry has been diagnosed with acute lymphoblastic 
leukemia. His treatment will last until at least April of 2018. He 
needs around-the-clock care to manage his nausea, vomiting, pain, and 
sleepless nights. Henry's immune system is so compromised that he is 
not supposed to go to daycare so Leanna left her job to care for him. 
Henry and Leanna are supported by Leanna's spouse, but they cannot pay 
for his treatment on one salary.
  Leanna says:

       It is because of the ACA that Henry gets proper healthcare. 
     Henry can get therapy and the things he needs to maintain his 
     health and work towards beating cancer. Henry is still with 
     us because of the ACA.

  He is 3.
  Let me say that again: ``Henry is still with us because of the ACA.''
  I will do everything I can to fight the Republican effort to repeal 
the Affordable Care Act, strip away consumer protections, and gut 
Medicaid.
  To all of my constituents who care about this, I need you to keep 
fighting. Now is the time to make your voices heard.
  I thank the Presiding Officer for his attention.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Mr. President, I am pleased to follow the Senator 
from Minnesota, as because of him I had the chance to be on the HELP 
Committee during all of those hearings--all of those dozens and dozens 
of Republican amendments that took place during the vibrant, robust, 
bipartisan process in the HELP Committee. Senator Franken was still in 
litigation over his election so his seat on the HELP Committee was 
vacant, and Harry Reid asked if I would take that seat. My senior 
Senator Jack Reed and I, both of Rhode Island, were there in the room 
day after day, week after week, while this exhaustive, public, 
bipartisan process went forward.
  I can even remember working with Senator Isakson, of Georgia, and 
supporting his amendment that would allow a doctor to be paid for 
having a conversation with a very ill patient about what his desires 
were if his condition did not get better. What type of end-of-life care 
did he want? Did he want every possible intervention or did he want 
dignified time at home with his family? What were his desires? That is 
a conversation that is important for doctors to have with those 
patients.
  In the environment of the time, that became the death panel phony 
story. So I was there. I saw it happen. Thanks to Senator Franken's 
delay in getting here, Jack Reed and I were in the room.
  Why does this matter? This matters because, like the story of Leanna 
and Henry, there are people on the other side of what is--apparently, 
for our Republican colleagues--a purely political piece of 
parliamentary chicanery.
  I have a constituent, a woman named Pamela, who lives in Jamestown, 
RI. She works with people and nonprofit organizations that advocate for 
people who have very rare diseases so, in her work, she has seen the 
before and after of the Affordable Care Act.
  ``Before the Affordable Care Act,'' she wrote to me, ``I saw many 
patients and families distraught by medical bankruptcy.''
  Then it came even closer to home for Pamela when she was diagnosed 
with stage IV breast cancer. If there were an annual or a lifetime 
limit on health benefits, she would be in deep trouble. If the 
protection for people with preexisting conditions were undone, that 
would imperil her ability to get insurance in the future.
  She wrote to me:

       As a patient myself, with a chronic, costly medical 
     condition, I am very worried that [these] protections will be 
     taken away, making my life-sustaining care unaffordable.

  Pamela deserves to be heard, but nobody can speak up for her with a 
bill that nobody can see.
  From Cumberland, Marilyn wrote to me. Marilyn is a family physician. 
She knows the healthcare system. She also has severe asthma. She has 
had asthma since she was a little child, and she manages her severe 
asthma with very expensive medication. Her husband is retired, and 
Marilyn purchased her health insurance through HealthSource RI--our 
ObamaCare health insurance marketplace--which, by the way, is working 
very well. There is no need to undo what is going on in Rhode Island. 
It gives her peace of mind, and she wrote to me to say she was 
terrified by the possibility that the preexisting condition clause will 
be allowed back in.
  She wrote:

       I am not a specialist but a family medicine physician, 
     doing the best I can to pay my student loans and daily 
     expenses. I could not afford the lifesaving treatment I 
     require to function. . . . I do not know how I would survive 
     financially if the current legislation the House has approved 
     is allowed to become law.

  Gina wrote to me from Lincoln, RI. Gina's daughter, Sofia, is 6. 
Sofia has cerebral palsy. We think we have problems here. I tell you, 
whatever the political problems we have over the Affordable Care Act, 
have a 6-year-old with cerebral palsy, and then come back and tell me 
you have a problem not liking ObamaCare.
  Sofia needs round-the-clock care and she gets it because of Medicaid. 
Gina wrote to me: ``From her home nursing care to her wheelchair, we 
could not live without [Medicaid].''
  Before Sofia came along, Gina and her husband never imagined they 
would need Medicaid; it never crossed their minds. But now, the welfare 
of their little daughter is entirely dependent on Medicaid. Depending 
on what we do here, Gina wrote:

       Will there even be a Medicaid then? This administration is 
     stripping benefits from the most vulnerable in our society. 
     How will they survive?

  The last story I will share is from Tony and his family, who live in 
North Kingstown, RI. Tony has a son whose name is Michael. Michael, 
right after he was born, was diagnosed with something called 
mitochondrial disorder. It is a severely, catastrophically debilitating 
illness. It left Michael severely disabled. Michael is 10 years old 
now, but developmentally he is more like a 3-month-old. He can't walk, 
he can't talk, he can't feed himself, but he is happy, and he is sweet, 
and he is a source of joy for his parents and his four siblings.
  Through Medicaid, Michael can receive up to 30 hours per week of care 
from a certified nursing assistant. It is

[[Page S3598]]

this program--it is Medicaid--supporting the certified nursing 
assistant those 30 hours per week that lets Michael live at home with 
his parents and those four siblings. Otherwise, he would have to be 
institutionalized. Somebody explain to me why a political victory 
shoved through this body after secret proceedings is worth explaining 
to Michael's parents that he is at risk of losing that coverage.
  When President Trump said that the House bill was mean, he was not 
kidding around. It is mean, mean, mean--dirty, rotten mean. And if you 
think the one on the Senate side is going to be any better, there is 
one little phrase I would like to bring to your attention: ``We're not 
stupid.''
  ``We're not stupid'' is what a Republican staffer said when he was 
asked, Why aren't you guys having a public process? Why are you trying 
to jam this through in secret? His answer: ``We're not stupid.''
  Well, what can you logically deduce from that? What kind of bill 
would be stupid to show the American public? If this was a bill that 
was going to be greeted with great applause and joy and relief and 
satisfaction by the American public, would you hide it? No. If it were 
terrible, if it would threaten people all across this country, then you 
wouldn't want them to see it. That would be stupid.
  So that is what they are up to. They know perfectly well that this 
bill is not good for America. That is why showing it to the American 
people would be, by their own words, stupid.
  Let me switch to my geek point before I go, because this is something 
I talk about a lot, and it bothers the heck out of me. This is a graph 
that shows healthcare in most of the countries that compete with us--
the OECD nations.
  This chart shows life expectancy in years. At the bottom is 72, at 
the top is 86, so where you fall in this shows where your life 
expectancy is in the different countries, and life expectancy is a 
pretty good measure of how good the healthcare system is.
  Here is the cost of healthcare per capita, averaged across the 
population. And as you will notice, most everybody is right up in 
here--Japan, Switzerland, Netherlands, United Kingdom. Most of our 
competitors, including France and Germany--they are up in here. Where 
are we? Out here. The most expensive other country in the world is 
Switzerland, which doesn't break $6,000 per person; we are over $8,000. 
The average in here, where Japan comes in, above where the United 
Kingdom comes in, is $4,000 per person; we are above $8,000. We are 100 
percent more expensive than the average and more than 50 percent more 
expensive than the least efficient other country in the world.
  So there is progress to be made at bringing costs down, if we would 
pay attention to this real problem instead of the imaginary problem of 
Americans having too much healthcare.
  And over here--look at the life expectancy in years. Look where we 
come in. We match the Czech Republic. So there is progress to be made 
on cost and on outcomes in this country. And, believe it or not, we are 
actually starting to make a little progress. Let me take my colleagues 
through this graph, and then I will leave you be.
  This top line was drawn by the Congressional Budget Office back in 
2010. They project forward into the future where they think healthcare 
costs are going to go. These are all Federal healthcare costs; the 
whole Federal healthcare costs, all of them piled up--Medicare, 
Medicaid, veterans--all of it. So here is what they projected it would 
be, this top line, in 2010. Then, they got to 2016, and they did 
another projection because they realized that as of 2014, things were 
coming in below their expectations. After the Affordable Care Act, 
things started to change. So they did another projection in 2016, and 
they projected this line right here.
  Those of us who serve on the Budget Committee know that we think in 
10-year increments. So here is a 10-year increment from 2017 to 2027. 
And if you look just at the difference between what CBO predicted in 
2010, before the Affordable Care Act, and what they predicted in 2016, 
after the Affordable Care Act: $3.3 trillion in savings--$3.3 trillion 
in savings. Think of what a difference that makes for our country if 
you can save $3.3 trillion in our healthcare costs.
  Healthcare costs are what is driving most of our debt and our 
deficit, so $3.3 trillion in savings? I tell you what, I want to see 
this bill because I want to know what CBO thinks about what happens to 
that $3.3 trillion in savings. If the cost of this Republican 
parliamentary chicanery is going to be losing $3.3 trillion in savings, 
the American people ought to know about that.

  So I call on my Republican colleagues to have a process. I don't know 
if the Presiding Officer has seen the bill yet. It is so close hold, I 
don't think all of the Republicans have even seen it. But for gosh 
sake, when you have these stories from Rhode Island and from all the 
other States around the country, when you have real fellow Americans 
counting on the healthcare that the Affordable Care Act made possible, 
the idea that you throw that out to score political points and to give 
super rich people a tax break is disgraceful. It is a disgrace.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Hawaii.
  Mr. SCHATZ. Mr. President, I want to give a status report on this 
bill. Right now, we think it is with the 13 men who are working on it 
in secret; they will show it to Republican lobbyists, and then they 
will send it over to the CBO for a score, and eventually the American 
public and the Senate will be able to see the bill.
  We will have a process called vote-arama, which is mostly nonsense, 
and there will be lots of opportunities to offer amendments, but let's 
be clear about what happens at the end of vote-arama. The leader will 
offer an amendment in the nature of a substitute. So what does that 
mean? That means all of the amendments that were adopted along the way 
get taken out, with one 51-vote margin, and all of that vote-arama was 
for show because Mitch McConnell will put his bill on the floor that 
was negotiated in secret with those 13 people.
  If there was any question that our democracy is being rolled over by 
Senate Republicans, I want you to think about these 13 men. They are 
drafting a bill without any input from women, from Democrats, from 
experts, and by working in secret they are cutting out about 250 
million people who are from the 40 States who aren't represented among 
those 13 men. You can bet that those 40 States have unique healthcare 
needs and unique healthcare laws. And without the right language, the 
bill could throw healthcare in each of those States or any of those 
States into total chaos.
  They have also cut out Senators on the Health, Education, Labor, and 
Pensions Committee and the Finance Committee, even though these 
committees are actually constructed for the purpose of working on 
legislation like this. They know how to get things done like this. 
There are members of the HELP Committee and the Finance Committee who 
are among the experts on this issue, yet they don't get a chance to 
even see the bill. These Senators have jurisdiction over this 
legislation, but they are being left out. This is just not the way it 
is supposed to work.
  We need transparency. We need bipartisanship. But now the Republicans 
will try to tell us that the hearings are bypassed all the time. That 
is not true. In fact, this body will hold a hearing on almost anything. 
In 2017 alone, the Senate has had hearings on hot tub safety, self-
driving cars, a treaty for outer space, multimodal shipping, the 
maritime administration, and dozens of other issues. Look, those are 
actually not to be trivialized. It is important for the Senate to have 
hearings. It is important for subcommittees to do their work. But 
nobody can tell me that hot tub safety, self-driving cars, a treaty for 
outer space, multimodal shipping, and the maritime administration are 
more important than one-sixth of the American economy. It is a joke.
  We are talking about one-sixth of the American economy, about 
millions of jobs, and about people with life-threatening diseases and 
life-changing medical bills, so we know how important hearings are to 
do legislation. When the Senate took up the ACA, there were almost 100 
hearings. Think about that: 100 hearings versus 0. There were 
roundtables and walk-throughs held by the two committees. We considered 
hundreds of amendments and accepted

[[Page S3599]]

more than 150 amendments from Republicans. But, for this bill, no 
markup, no transparency, no bipartisanship--just 13 men meeting in 
secret outside of the regular process.
  The only thing that has changed is now the market is under siege, but 
the market is under siege because of the Republican administration. 
They are purposefully creating uncertainty. That is not a rhetorical 
flourish; they are saying they are doing that. President Trump actually 
said he wanted to create uncertainty in the healthcare market in order 
to create leverage with Democrats.
  Think about how unusual that is. Think about how offensive that is. 
It is perfectly appropriate for one party to try to generate leverage 
in a negotiation against the other. That is part of politics, either in 
an election context or in the public policy context. But the way that 
this President and Tom Price are trying to generate leverage is by 
raising healthcare premiums in order to force Democrats to buckle. That 
is unheard of. It really is unheard of. And it hurts everybody across 
the country to create this uncertainty.
  It is bad enough that the Republicans are trying to take healthcare 
away from 23 million people--from nursing home patients and their 
families, from women who are pregnant or fighting breast cancer, from 
sons and daughters and moms and dads who struggle with opioids. But to 
add insult to injury, they are going to jam it down your throat. You 
don't get to read what it is about before it passes or hear from 
doctors or nurses or experts about how it will affect you.
  So why are they working on this bill in secret? The answer is very 
simple. The bill stinks. They are ashamed of it. The bill itself is an 
embarrassment. The process is an embarrassment. They have said so 
themselves. No matter how you look at this, this bill is a disaster for 
people and their families. It will be a disaster for anyone who relies 
on Medicaid, which will be cut by at least $800 billion, and Medicaid 
is a safety net for people who need care but can't afford it.
  Look at nursing home care. Medicaid covers three out of every four 
long-stay nursing home residents. My wife's grandmother was in a 
nursing home and just passed away, had great care, and wouldn't have 
been able to get the care she needed were it not for Medicaid. This is 
not an uncommon story--millions of Americans across the country of all 
income levels. People think of Medicaid as for people who are not 
financially in a position to get care in any given moment. That is 
true. It does take care of the poor. But it also takes care of nursing 
home care for people who worked all their lives and just don't have 
enough. It is $9,000 a month in the State of Hawaii for nursing home 
care. It is more than that for hospice care. We all know that nobody 
escapes end-of-life care. Rich or poor, left or right, red, blue, 
purple, nobody escapes this part of your life, and everybody needs 
help. There might be a few people who save up enough cash money to be 
able to shell out $10,000 a month for that kind of care, but for the 
rest of us, Medicaid is that lifeline.
  There are actually some Republicans who don't want to cut Medicaid. 
They have seen how the program improves people's lives. Arkansas and 
Kentucky, for example, expanded Medicaid. These States have seen big 
jumps in the number of the people who now have their own doctor or have 
gotten a checkup in the past year, people who are now more likely to 
say they are in excellent health. But under TrumpCare, we will be back 
to the bad old days.
  This bill is also a disaster for older people, who will be hit with 
what the AARP is calling an age tax. This will get a little wonky--not 
as wonky as that referred to by my colleague who spoke about 5 minutes 
ago but a little wonky. Right now, companies are not allowed to charge 
any more than three times as much for an older person as a younger 
person. Three times is the cap. But TrumpCare will increase that rate 
to five times. So what happens is every year, as you get older, your 
insurance costs will go up and up and up. That is why they call it an 
age tax. In other words, many seniors will see premium increases that 
can cost them thousands of dollars more each year at a time when people 
are already struggling to find money to pay for healthcare.
  This is also a disaster for patients who don't want to lose their 
healthcare provider. Right now, an estimated one in five women goes to 
Planned Parenthood clinics. I understand we have different views about 
reproductive choice. I understand that. But we also understand--when we 
are talking on the level about Planned Parenthood and when we are 
talking about Federal funding for Planned Parenthood, everybody who 
pays any bit of attention to this understands what Planned Parenthood 
does for women across the country--again, conservative women, 
progressive women; Planned Parenthood doesn't care. Planned Parenthood 
is not using Federal funding for abortion. We all know that by now. It 
is cancer screenings, and it is quality healthcare and birth control.
  People talk about giving more choices for healthcare and saving 
taxpayers' money, but the CBO estimates that defunding Planned 
Parenthood will take away options for nearly 400,000 women across the 
country and will cost taxpayers more than $130 million.
  It is also a disaster for those struggling with opioid addiction. 
This bill will take away treatment for mental health and addiction, 
leaving hundreds of thousands of people fighting opioid addiction 
without adequate health insurance. We saw the statistics that opioid 
addiction, I believe, is killing more people annually than HIV/AIDS 
killed at its apex. I believe it has either surpassed or is comparable, 
in terms of cause of death, with car accidents. This is one of the 
leading killers in the country, and Medicaid is the program that funds 
opioid addiction for most of the people who get help.
  This bill is also a disaster for patients with preexisting conditions 
because it means we will be going back to the dark days when insurance 
companies could charge you more for having a preexisting condition.
  I have heard from people back home in Hawaii who are terrified of 
what this could mean for their health. One woman wrote that she is in 
the middle of a fight for her life against breast cancer, and she is 
scared that under TrumpCare, she will lose her insurance, that she will 
have to stop her treatments and could lose her life. A husband wrote to 
me that his wife has stage IV breast cancer. She has had every possible 
treatment and surgery imaginable to extend her life, but without the 
guarantee of affordable coverage for all, her fight will quickly come 
to an end. She is 29.
  Even people without serious medical conditions will be affected by 
this preexisting condition's nonsense. We know that because before the 
Affordable Care Act became law, insurance companies were able to 
discriminate based on what they determined to be a preexisting 
condition.
  One woman in Hawaii told me that in the days before the Affordable 
Care Act, she was rejected by insurance companies because she had back 
pain at one point in her life. The pain never came back, and she never 
needed treatment again. She was young and healthy, but the insurance 
company wouldn't give her insurance.
  We cannot accept the end of nationwide protections for people with 
preexisting conditions. We cannot accept high premiums or so-called 
high-risk pools that have historically failed in giving people the 
coverage they need and deserve. We don't have to do it this way.
  We don't have the majority, and this is being done under a process 
called reconciliation, which means that you don't need a filibuster-
proof majority; you just need 51 votes. So if you are proud of your 
bill--we have Senator Hatch, chairman of the Finance Committee and one 
of the most respected Republicans in the country, actually. We have 
Senator Alexander, chairman of the Health, Education, Labor, and 
Pensions Committee. Both have a long history of being able to do 
deals--Orrin Hatch with Teddy Kennedy and my predecessor, Dan Inouye; 
Lamar Alexander with just about everybody--Chuck Schumer, Patty Murray. 
These are conservative Members of the Senate. There is no doubt about 
their Republican credentials. But they are also people who are capable 
of crafting legislation in the right way. I have no doubt they like 
their gavels. I have no doubt they like chairing hearings. I have no 
doubt they have the personal, intellectual, emotional, and political

[[Page S3600]]

stamina to go through a process which may take more than a couple of 
days.
  I will tell you, this is the world's greatest deliberative body--it 
is--and these are a bunch of impressive people I serve with in the 
Senate. But without a hearing, you get a garbage product. You get a 
bill that just stinks, that staffers say they are keeping secret 
because ``we're not stupid.'' They are so embarrassed at this product 
that they are keeping it secret, because they know the moment this 
thing gets posted, everybody from everybody's home State--and not just 
Democratic States and not just purple States, but every home State is 
going to say: My community health center is going to get shut down. My 
opioid treatment center is going to get shut down. My hospital may no 
longer exist.
  They know this bill stinks.
  There is a simple solution. All we need is three Republicans to say: 
Let the Senate be the Senate. The House did whatever the House was 
going to do.
  There was a weird White House Rose Garden signing ceremony without a 
bill even being enacted. It was the most bizarre thing I have ever 
seen, where everybody was congratulating each other for inflicting pain 
on the American people.
  But the Senate has to be the Senate here, and what that means is that 
we have to be that cooling saucer. We have to actually slow down and 
have a deliberative process. All we need is three Members of the Senate 
on the Republican side to say a very simple thing. They can be as 
critical of ObamaCare as they want, they can be as partisan against us 
as they want, but all they have to say is this: I am not voting for a 
bill that doesn't get a hearing. I am not voting for a bill that 
doesn't get a hearing. Let this thing see the light of day.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Young). The Senator from Connecticut.
  Mr. MURPHY. Mr. President, I thank my friend from Hawaii for 
convening us here tonight.
  This isn't theoretical. This isn't about numbers. This is about real 
people. We know them. They exist throughout our States.
  I have told this story a few times before on the floor of the Senate. 
When I think about the progress that has been made over the course of 
the last 6 years, I think about Betty Burger. Betty is a woman who 
lives in Meriden, CT. Betty and her husband did everything we asked 
them to do. They were morally upstanding citizens, contributed to their 
community, had full employment, raised good kids.
  Her husband switched jobs. He switched jobs, and he had a 1-week, 
maybe a 2-week period of time in between those two jobs. As luck--or 
lack of it--would have it, during that brief intermission between 
employment, their son was diagnosed with cancer. The cancer then became 
a preexisting condition, which meant her husband's new employer would 
not cover the son as part of a family plan. The cancer progressed and 
progressed and progressed, and this family, the Burgers, had no means 
to keep up with the payments.
  Their story, unfortunately, is not foreign to folks who have heard 
from constituents who have gone bankrupt because of healthcare costs. 
The Burgers lost everything. The Burgers first went through their 
savings, then they went into their son's college account, then they 
sold their car, then they sold their house. They lost everything they 
had trying to make sure they had healthcare for their son simply 
because he got diagnosed with cancer during the one tiny interim 
between their family's insurance coverage. That preexisting condition 
doomed that family. There but for the grace of God--that could be us. 
That could happen to any one of us.
  Yet, today, medical bankruptcy is, frankly, a thing of the past. Why? 
Well, it is not because healthcare costs any less; it is because we 
said we are not going to allow insurance companies to deny coverage to 
someone because they have a cancer diagnosis. In fact, we are not going 
to allow insurance companies to charge you more just because you are 
sick. Guess what. People have been able to keep their college savings 
account. They have been able to keep their car. They have been able to 
keep their house even if they get sick. That is what this bill has 
meant. Twenty million more people are insured, yes, but the number of 
personal bankruptcies in this country has plummeted by 50 percent, 
almost entirely because there aren't Burgers any longer. There aren't 
people who had to live through what the Burger family had to live 
through.
  That is what this is about. This is about real people who are going 
to go through miserable, terrible experiences because of the bill 
Senate Republicans are just days away from putting onto the floor.
  I know my colleagues have covered this exhaustively, but I just want 
to show visually what CBO says the House bill does.
  I know it is in vogue for the President and Republicans to say that 
ObamaCare is in a death spiral, but that is not what CBO says. CBO says 
that if you keep the Affordable Healthcare Act and actually implement 
it rather than undermine it, rather than sabotage it, as the President 
of the United States is today, the number of people who don't have 
health insurance will remain fairly stable from 2017 to 2026. It is 
about 28 million people. But if you enact the American Health Care Act, 
the bill that passed through the House, that number goes almost 
immediately from about 26 million up to 40 million. Right about 14 
million people lose insurance right off the bat. Like within a 
heartbeat of passing this bill, about 14 million people will lose 
insurance, and then, over time, it grows to 51 million people. That is 
not the affordable healthcare act in a death spiral. That is market 
stability. This is a death spiral. The death spiral starts upon passage 
of the act being secretly negotiated today.
  I get it that 23 million is kind of a hard number to get your head 
wrapped around. What does 23 million people really mean? These numbers 
are so huge. So here is what 23 million people is. It is the entire 
population of Alaska, Delaware, Hawaii, Idaho, Kansas, Maine, Montana, 
Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, South 
Dakota, and let's just throw in West Virginia. That is what 23 million 
people is. That is a humanitarian catastrophe.
  Remember, 23 million people is what you get to at the end of 10 
years, but 14 million people lose it right off the bat. There is no way 
for our healthcare system to provide coverage to 14 million people who 
had insurance one day and then don't have it the next. By the way, they 
tend to be the sickest people because that is who is going to lose 
healthcare first.
  Why are we doing this? Why would you choose to inflict this kind of 
pain on people? Why would you ask to run for Congress in order to put 
this kind of hurt on the American public?
  Here is the answer. I wish this weren't the answer. I wish there were 
a different answer, but here is the answer. Twenty-three million people 
lose health insurance, and the cost of that is about $800 billion of 
money out of the healthcare system. It is not coincidence that that 
then gets transferred into 650 or so odd-billion dollars in tax breaks 
for the pharmaceutical companies, the insurance companies, and for 
really, really rich people. It is not just by accident that it worked 
out that the amount of money you took from poor people and from middle-
class people and from sick people is the exact amount of money you are 
transferring to the pharmaceutical industry, the insurance industry, 
and rich people.
  Here is another way of looking at it. Here is where the tax cuts go: 
The lowest quintile, the second quintile, the middle quintile, even the 
fourth quintile don't get a lot of money out of this tax break. It is 
the top quintile, the top 20 percent of income earners who get an 
average tax cut of $2,700.
  Here is the big benefit: The top 1 percent of income earners--a 
$37,000 tax cut out of this bill. The top 1 percent of income earners 
get a $37,000 tax cut from this bill. Let me say that again: 23 million 
people lose healthcare so that the top 1 percent of income earners get 
a $37,000 tax cut. Who runs for Congress to do that? What constituency 
is asking for the U.S. Congress to pass a bill that takes health 
insurance from all sorts of working Americans, people who are playing 
by the rules--people like the Burgers--in order to pass a tax cut for 
the super wealthy?
  I don't know what is happening behind those closed doors. I don't 
know

[[Page S3601]]

exactly what they are talking about, but I am going to guarantee you 
that it is not fundamentally different than what the House bill did, 
which is what I am describing here. There are still massive numbers of 
people losing healthcare, rich people getting a tax cut, and lots of 
folks getting hurt. Why? Just because Republicans made a political 
promise to do this.
  I know I have other colleagues who want to talk. Let me turn for a 
moment to this process because the process does matter. The majority is 
breaking the Senate. They are breaking the Senate. Don't think this 
will not be how this works if you are in the minority. The fact is, we 
acknowledge that there is a lot that is still very wrong with the 
American healthcare system. Our constituents command us to try to make 
those things better. We would love nothing more than to sit down with 
the Republicans and try to figure out how we can come together on a 
path forward to make this healthcare system better. I know you don't 
believe us, but you didn't even try.
  I am not sure we believed you at the beginning of 2009 when you said: 
We want to help people get insurance. We watched Republicans have 
control of the Presidency and the House and the time Senate for a long 
time without a lot of progress being made, but Democrats tried.
  Democrats spent a whole year sitting down with the Republicans, 
trying to figure out if there was common ground--holding committee 
processes, exhaustive hearings. There were 30 days of Senate debate on 
the floor. I get it; in the end Republicans didn't support that 
package. I get that Republicans can lay blame at the feet of Democrats 
for not crafting something that could win Republican support. I 
understand how that argument works.
  The fact is that when Democrats were in the majority, they tried. 
They opened up the committee process. They let everyone in the public 
see the debate we were having. Why? Because it is a big deal.
  We are talking about one-fifth to one-sixth of the American economy. 
If you are talking about reordering that biggest segment of the U.S. 
economy, if you are talking about millions of people benefiting or 
losing, that shouldn't happen behind closed doors.
  My constituents, even though they are represented by Democrats, have 
no fewer rights than the citizens of Iowa or the citizens of Texas who 
are represented by Republicans. Why are my constituents not allowed to 
see the details of what is about to happen to their lives? Why are only 
a select group of Americans able to have a voice inside that room? Why 
are the people of Connecticut going to get 3 minutes to look at this 
bill once it hits the Senate floor? My constituents are Americans, just 
as the constituents in Republican States are Americans. They deserve to 
know what is about to happen to them.
  You are breaking the Senate. It will not get put back together that 
easily. These are tough questions. They are partisan questions, but it 
doesn't mean there is not an obligation to try to find common ground. 
If you can't find common ground, don't bury the proceedings behind 
closed doors where nobody can see it.
  People hate this bill. They hate this bill. They hate it in part 
because they don't trust the process. When they see this balance--tax 
breaks for pharma, insurance, and rich people--and then losing 
coverage, they want to know why they lose and why super rich people 
win, but they can't get answers because it is all happening behind 
closed doors.
  It is not too late. I will just end there. Senator Schatz said it 
right: It is not too late. My Republican colleagues can reject this and 
say: Let's start over. Let's sit down and see if there are some 
Democrats who want to work on stabilizing these exchanges, seeing if 
there is some middle ground, being able to build a bipartisan consensus 
when it comes to the future of the healthcare system.
  It is not too late. I think you are going hear that consistently from 
my colleagues this evening.
  I yield the floor.
  Mr. BOOKER. Will the Senator yield for a question?
  Mr. MURPHY. I have yielded the floor, but I will happily engage in a 
colloquy.
  Mr. BOOKER. Mr. President, can I ask the Senator from Connecticut a 
question?
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BOOKER. Thank you very much.
  The Senator's charts plainly showed who benefits from the Republican 
bill that we saw in the House. The CBO, as he pointed out, plainly 
demonstrates that 23 million Americans will lose healthcare. I have 
heard him talk about this on other issues--how we as Americans are far 
more connected than we realize and that while one family might suffer 
from lack of health insurance--like the folks he talked about in the 
beginning of his remarks--the reality is that when that child doesn't 
get the healthcare they deserve, when they don't achieve in life the 
great potential they might have, others suffer as well. You see this as 
you travel to European countries. They have vastly more people insured, 
vastly more investments in childhood education and childhood 
healthcare.
  I am wondering if the Senator can extrapolate for me for a moment 
that this isn't just about individual families who are vulnerable. It 
is really all Americans, who suffer when other Americans are not 
getting the benefit of healthcare in this country.
  Mr. MURPHY. I think we all got a gut punch earlier today. We received 
news that the young man who just returned from North Korea, after being 
abused and tortured there, had passed. If you read the statement from 
his family, it was hard to read. You couldn't help but read that 
without feeling your heart drop into your stomach. Why? Because this 
was a young man with such promise ahead of him, who had that future 
robbed from him.
  I didn't know him. My colleague didn't know him. The people in my 
State who were similarly affected didn't know him, yet they felt 
something.
  I think the reason this bill is so wildly unpopular is that people 
are going to die. The fact is, if people don't get coverage for 
addiction, if folks who are mentally ill don't get to see a doctor, 
they aren't going to survive. Even those who have enough money to be 
able to pay for the premium increases in this bill--they know there is 
something a little evil in wanting to do this to people.
  As my colleague remarked, even if you are not amongst the 23 million 
people who lose insurance, the CBO also says your rates are going up 
because when those people don't get health insurance, they show up 
somewhere else in the system. They show up at the emergency rooms. They 
get much more expensive care. That cost gets passed on to the rest of 
us.
  Even if you are lucky enough not to be amongst the 23 million, you 
are going to be personally, financially affected by this. The CBO says 
that everyone's rates will go up by 15 to 20 percent. Even if it is not 
the money you care about, we are all connected, and nobody should want 
this to happen to people. We are all weaker if we pass a piece of 
legislation that ends up hurting people in such a real, meaningful, and 
devastating way.
  Mr. BOOKER. If I can ask the Senator from Connecticut one more 
question--that interrelatedness is a part of a larger system. We all 
benefit from these systems. My colleague mentioned hospitals, and 
whether it is my family who gets injured and is rushed to a hospital or 
a wealthy family or a poor family, those hospitals are a critical part 
of the healthcare system.
  I was mayor of a city, and I imagine my experience is similar to that 
of the Senator from Connecticut. Our hospitals before the Affordable 
Care Act were having a really difficult time because so many of those 
costs at the most expensive point--when a disease had become so much 
more acute--were being pushed into hospital emergency rooms. My State 
was having a very difficult time with the costs of that charity care. 
They literally had tough choices. They weren't going to close their 
doors when somebody went into diabetic shock or someone had an asthma 
attack or some of those diseases were not treated at an earlier stage.
  I am wondering if the Senator can help explain, in terms of 
Connecticut's perspective, why this has an impact on all of us in terms 
of the systemic healthcare systems that sustain our communities.
  Mr. MURPHY. I think it is important to understand what the law says. 
The

[[Page S3602]]

law says there is only one healthcare provider that by law has to treat 
every single person who comes in the door; they can't turn away 
individuals based upon their ability to pay. That is the emergency 
room.
  What we also know is that the emergency room is the place you get the 
most expensive care. By the time you get there, you are often in 
crisis. The care you receive in the emergency room is expensive, and 
then all of the care you need afterward is expensive as well.
  I always remember a woman from Connecticut who lost her Medicaid 
coverage. In losing her Medicaid coverage, she didn't end up being able 
to see a doctor for an infection she had in her foot. It was hurting 
her for a long time, that infection. She didn't have Medicaid any 
longer, so she just decided to let it hurt. She popped some Tylenol and 
hoped it would go away. One day it was so painful that she went to the 
emergency room, and it was too late. It was too late. Her foot had 
become so badly infected that she had to have that foot--that leg below 
her knee--amputated.
  She had no insurance, so we all picked up the cost of that, but she 
had her life altered in a way that is hard for us to fathom, and there 
is not a single winner in that scenario because, obviously, her entire 
life is changed because of that.
  It is not as if we had saved any money in treating her so shabbily 
because we ended up having to cover all of those costs. That is one 
story. If you think about what the House bill does, it repeats that 
story millions of times over. It is morally bankrupt, but it is also 
fiscally imprudent and foolish.
  Mr. BOOKER. That brings up one more issue, if the Senator will 
indulge me, because I just visited his State. As I was talking to a lot 
of his members--being from New Jersey, there might be a small rivalry 
between our two northeastern States. A couple of folks came up to me 
and got in my face in a polite and joking way about how our 
Constitution was formed. They talked about the Connecticut Compromise. 
As you well know, this was a compromise that allowed our Republic to 
form, understanding they would have two bodies, the House and Senate. 
Every State would have two Members representing it. In many ways, the 
Founders of our country, coming out of this, viewed this body very 
differently than the other body.

  Now, the other body, you served in. I am hoping maybe you can shine 
some light. I have been here 3\1/2\ years. You had experience as a 
House Member and as a Senator. You said something some people at home 
might dismiss as hyperbolic partisanship, but I have been here 3\1/2\ 
years, and I have seen this body change. What frustrates me is that 
when I was here for a brief period of time and Democrats were in the 
majority, I heard Republicans talk about regular order, how urgent 
regular order is. When we are in charge, we will have regular order. 
The leader spoke publicly about this thing called ``regular order.'' 
The House operates on majority rule. Our Founders saw that as a very 
different body than this, which is in many ways talked about as a 
different rhythm--a different way of doing things. In fact, one Senator 
over here can have a lot of power within this system, sometimes to the 
frustration of folks, to slow things down.
  You made the claim about this being broken. This is a perfect example 
of it--this idea that this would be the body, on such a big issue, that 
would have a chance to be deliberative and to focus on this. I think 
you are right. We have seen this body, in the very short period of time 
I have been here, begin to undermine not just things that happened 
under the Obama administration but to undermine traditions that go back 
decades, if not more than a century.
  I wonder if, being that State, as I was told, so critical to our 
Constitution, you could give some light on why you really are 
substantively, factually saying that this is probably one of the low 
moments of the Senate in the way that this process is being done.
  Mr. MURPHY. There is, right outside this Chamber, a picture of the 
authors of the Connecticut Compromise, two of the Connecticut delegates 
to the Constitutional Convention.
  Mr. BOOKER. They might have been born in New Jersey.
  Mr. MURPHY. I appreciate that shout out to Connecticut. You are 
right. The idea of the House is that it is supposed to respond, 
perhaps, more quickly to the temporary passions of the public, which is 
ironic, given that the passion of the public today is in deep 
opposition to this piece of legislation. Unfortunately, the House is 
responding to the passions of one very small portion of the public, 
which is the extreme Republican base, which maybe is the only remaining 
segment of this country that supports the American Health Care Act.
  This place is supposed to be able to step back and look at the long 
term and look at the long view. That is why we have 6-year terms, so we 
don't do something that may feel good in the moment politically but has 
devastating impacts over the course of time. That is exactly what this 
debate is about. It is about a massive reordering of one-fifth of our 
economy that has just enormous consequences over time, when these 
people who lose insurance start to feel the effects of that as they 
bleed through their savings over 5 or 10 years and go bankrupt at the 
back end of that time period.
  So this is a place where both parties should be able to sit down and 
talk about what this really means for folks. I thought Senator Schatz 
put it well. When you don't engage in regular order, not only do you do 
things that are very partisan and political, but you also do things 
that don't make sense.
  One of the things that regular order brings is the ability to talk to 
experts. We all sit on committees, and those committees bring experts 
to the table to tell us what the impact of legislation is. There has 
been no committee process on this bill. We haven't had a single 
committee meeting. We had one hearing in the HELP committee upon which 
I sit.
  So as Senator Schatz said, the result is a product that is garbage--
that, logistically, does not work because neither the House nor the 
Senate engaged in the kind of deliberation that would get you to the 
facts. Yes, this place is supposed to work differently, but also you 
are supposed to use the committee process to make sure that you are not 
passing something that just makes sense politically but makes sense 
from a policy standpoint as well.
  Mr. BOOKER. I thank Senator Murphy for giving me those few moments.
  I wonder if the Chair would recognize me to give a few remarks 
myself.
  The PRESIDING OFFICER. The Senator from New Jersey is recognized.
  Mr. BOOKER. Thank you very much, Mr. President.
  I want to pick up on that conversation that we were having, in which 
Senator Murphy laid plain on his charts about larger issues with this 
bill. I want to get back to the point he was just talking about and 
that I observed here in the Senate for about 3\1/2\ years, and that is 
the functioning of this body. I love history. I am one of these guys 
who doesn't read any fiction any more. I love reading about this 
country, about its past leaders, about great moments in history.
  What is interesting about this body is that, being someone who has 
the privilege to stand on this floor--quite literally, given to me by 
the State that I love, New Jersey--I walk on this floor and I feel a 
sense of history every time I am here. It has been 3\1/2\ years, and it 
hasn't lost its ``wow'' factor for me that I get to stand on this 
floor. I have to say that I love my State, and in my campaigning, I 
don't think the issue that I am New Jersey's first Black Senator came 
up that much. New Jerseyans wanted to know: Would I come down here and 
fight for them? I was aware of the history of being the fourth African 
American popularly elected in the history of this body. I came down 
here as a student of many of the great moments in time on this floor 
and many of the records that were set.
  I think some of those records are really germane to this moment right 
now. The longest filibuster on this floor is where one Senator could 
actually grind the workings of the Senate down to a crawl because of 
Senate rules and Senate traditions. In this case, it is something I 
wasn't even alive for, but something that, to me, is frustrating. But 
it is a moment of history that shows what regular order is. It slows 
down this body.
  A filibuster takes 60 votes to overcome. So here was this moment. It 
was

[[Page S3603]]

actually almost exactly 60 years ago. That was the 1957 Civil Rights 
Act. It was Strom Thurmond who gave this long filibuster, trying to 
block something that--yes, indeed--was going to have societal impacts 
on this country--the 1957 Civil Rights Act. This is one illustration of 
how, when monumental pieces of legislation come to this floor, the 
history of this body and the traditions of this body are to slow things 
down, to have a process, to have rules--especially for things that are 
so monumental. In this case, it was the 1957 Civil Rights Act--
something on which we look back in the past and say: Wow, it took them 
a long time to get there, but it demonstrates what this body's rules 
have been about for a long time.
  Let me go with another record that I mentioned earlier tonight, but 
it shows, again, that when monumental pieces of legislation are coming, 
this is a body that looks closely, takes its time, is deliberative, and 
has a time-honored process. That is the other record set by the longest 
consecutive session in Senate history. It was a debate about truly one 
of the more important things in our society, which is issues of war and 
peace. The longest consecutive session in the Senate history of debate 
and of deliberation--open and public, not just for the Nation to see 
but for the world to see--was a debate during the First World War about 
whether to arm merchant ships. It brought about tremendous 
consternation, tremendous debate, as we did the lead up to the First 
World War. What is interesting is, if you think about the forming of 
our country in that debate--again, the Constitutional Convention was 
public, open, transparent--issues were debated. One of the fundamental 
reasons for organizing our government was seen as the protection of the 
American people, the ideals of a common defense, and the public 
welfare. These were the things, literally, put into the preamble of our 
Constitution, about what this government is about--that these are the 
most important ideals. In fact, we herald some of these ideals. They 
have become part of our civic gospel. Everyone knows when they hear the 
words ``liberty and justice for all'' that they are part of our civic 
gospel.
  Part of that gospel, as well--in the core center of our country--is 
that this is a nation about life, liberty, and the pursuit of 
happiness. As to that word ``life,'' this government, this Republic is 
affirming the ideals of life. It is only understandable when we are 
debating epic pieces of legislation that will go to affect the lives of 
tens of millions of Americans.
  I was in the children's hospital today. Families in peril, families 
in crisis were talking about the lives of their children. I have seen 
it happen, unfortunately, to neighbors and people of my community. When 
the lives of their children are at stake or threatened or afflicted 
with disease, it puts so many things in perspective.
  So here we have legislation speeding its way to the Senate floor that 
goes to the fundamental ideals of this Nation. Will we be a country 
that has a system of healthcare that affirms life?
  When we are talking about records in the Senate, it is no coincidence 
to me that one of the longest times that there was a consecutive 
session in Senate history for debate--no coincidence to me--was about 
war and peace. It was the rush, as some people saw it then, toward war 
in World War I. What is fascinating is that folks should know that the 
second longest consecutive session in Senate history was about 
healthcare. It was in 2010. It was over the Affordable Care Act, a bill 
that the full Senate spent 25 consecutive days considering, 160 hours. 
Those 160 hours in session does not include hundreds more hours in 
committee hearings, in meetings. All that took place in the development 
of a bill that came to this floor and set a record about being the 
second longest debate.
  It is perfectly justifiable that the bill should have taken so much 
time, so much focus--that the world's greatest deliberative body would 
deliberate, would do its job. As for that piece of legislation, don't 
believe the lie; it wasn't rushed through here. It didn't get the 
express train through the Senate. It set records for discussion, 
deliberation, debate, and a process that included comments, input, 
thoughts, and testimony from Americans across the country--not just red 
States, not just blue States, but of all Americans. It was justifiable. 
It was absolutely justifiable.
  I wasn't here. I was at home in Newark. I was mayor of the city.
  This debate went on and on and on, and it captured the attention of 
the Nation. It was something I had never seen before and I haven't seen 
since. The President of the United States then, Barack Obama--this to 
me was stunning; it caught my attention--was on national TV cameras. 
Sure, it was C-SPAN--not what I turn to first when I am home relaxing 
on my couch. But the President of the United States invited Congress 
in--Republicans, some of the smartest minds. I have served here 3\1/2\ 
years now. Some of the smartest minds I have met in this country are 
here in the Senate on the Republican side. He invited the Congress in 
to discuss and debate with him on live TV healthcare. I don't know if 
Reagan did that. I don't know if Bill Clinton did that. I can't 
remember that they did. So here was something that was done fully in 
the light, vetted, debated, deliberated, discussed in open air.

  The hearing numbers are incredible. I have been here 3\1/2\ years, 
and I have never seen anything like it. In the Senate's so-called HELP 
Committee--Health, Education, Labor, and Pensions--they held 14 
bipartisan roundtables, 13 bipartisan hearings, 20 bipartisan 
walkthroughs, and they considered 300 amendments. This is the thing I 
didn't know until I got to the Senate because of all the rhetoric on 
24-hour cable news. This wasn't a purely Democratic bill. They actually 
accepted over 160 amendments from Republicans. The stories I have heard 
from people on both sides of the aisle is that they were bending over 
backward trying to pick up one Republican vote, so they incurred and 
took on amendments that actually shaped the bill, Republican ideas onto 
this healthcare bill, 160 amendments. But stop, that is only in the 
HELP Committee.
  In the Senate Finance Committee, they held 17 bipartisan roundtables, 
they held summits and hearings, 13 member meetings and walkthroughs, 38 
meetings and negotiations, bipartisan. They held a markup. I have been 
to lots of markups. I have never seen them last or scarcely can think 
of times they have lasted for more than a day, but they held, in the 
Finance Committee, a 7-day markup on the bill. That 7-day markup--talk 
about records--that 7-day markup was the longest markup on a bill in 20 
years. That was the process.
  A bill affecting that fundamental American ideal that this Nation--
founded like no other, not a theocracy, not a monarchy. It is the 
oldest constitutional democracy on the planet Earth that affirmed 
ideals that put into the ether of Earth, for the first time, this 
Constitution, talking about life, liberty, and the pursuit of 
happiness. This healthcare bill involved such debate and discussion and 
the Nation participated. Policy experts, market experts, medical 
professionals, health nonprofits, insurers, hospitals, Americans all 
got to put forward their input, their ideas. Sure, all of them were not 
accepted, but everything went into the mix.
  This should be shocking to the consciousness of all people of good 
conscience who aren't reflexively partisan, but look at the history of 
this country, a history that is proud, a history that should be 
shameful about how things got done in matters of war and peace, in 
matters of foreign policy and domestic, in matters like integration and 
civil rights that made it possible for me to stand on the Senate floor. 
There was a process, and somehow in the last 3\1/2\ years--in the name 
of what? A vicious brand of partisanship that somehow undercuts not 
just the voice of Democrats, not just the voice of policy experts, not 
just the voice of hospital experts, not just the voice of medical 
professionals--it doesn't just undercut their involvement in the 
process, but it is an insult to the history and the traditions of this 
body.
  This was not the constitutional intent that something as important as 
healthcare should be done in a back room where a small handful of 
Senators are trying to hammer out amongst themselves a piece of 
legislation that is going to affect tens of millions of Americans and 
change our economy and change our communities. There is honor in this 
place that isn't

[[Page S3604]]

on TV. There are good folks on both sides of the aisle. I have gotten 
to know them. I consider folks my friends. I know their hearts. This 
does not sit well the way this is being handled. I know it.
  This is one of those moments of history that somebody just needs to 
raise their hand and say: You know what. I might even like that bill 
that comes out of that back room. I may like that bill that was 
hammered out by 12 Republicans, but this process is wrong. It is an 
insult to our history. I wouldn't want this done to me.
  This is the moment. It is a test. History will look back and see what 
this body did at this moment in history. I fear we are going to fail 
the test.
  What is even more painful than that, for me, is not just the sadness 
or the anguish I feel about a body contorting its traditions, breaking 
its way, what even hurts me more than that is what they are going to be 
pushing through. We saw it in the House.
  Instead of this body coming together--and literally there is 
agreement on this. All of us believe the Affordable Care Act needs to 
be improved. I have had it in conversations, formal and informal, that 
we could build upon the Affordable Care Act. We could correct for its 
deficiencies, and we could build upon its extraordinary successes.
  I see those extraordinary successes in my State. I have Republicans 
and Democrats who are now fearful about the consequences should a bill 
like the House Republican healthcare bill be made law. There are folks 
who fear for their families, fear for their children, who don't want to 
go back to the Nation we had before, where the No. 1 reason for 
bankruptcy was not being able to afford your medical bills, where 
people with preexisting conditions were denied insurance, when mental 
healthcare wasn't in parity with physical healthcare. I can go through 
all the things I have seen make a huge difference in New Jersey in 
communities, rural and urban, for Americans.
  I want to highlight some of those right now, some of those questions 
that people are asking at home about what happens if a bill like the 
House bill becomes law, if they take that bill here in the Senate and 
push it through, send it back to the House this bill that subverted 
process, inclusion and debate and deliberation, and go to that process 
called reconciliation. There are questions that are being asked.
  Here is one: What happens to a mother who is pregnant with, say, her 
second child who suddenly loses Medicaid coverage? Now, understand, a 
very large percentage of the children born in the United States of 
America are born covered by Medicaid, which we already see in this 
House bill is being gutted, which is the biggest rollback in the safety 
net in our country in my lifetime and more.
  What happens to that mother who is pregnant with her second child and 
loses her Medicaid coverage and her prenatal care? If she loses her 
prenatal care along with it, what happens to that American citizen? 
What happens to that baby?
  Well, we know that according to the U.S. Department of Health and 
Human Services, babies born to mothers who receive no prenatal care are 
five times more likely to die than those whose mothers did receive 
prenatal care. Tragically, women without prenatal care are three to 
four times more likely to suffer maternal mortality--that means dying 
in childbirth--than women with prenatal care, and these rates 
significantly increase for women of color.
  What happens to the tens of thousands of mothers who may lose access 
to maternity services, and what happens to the already dismal infant 
mortality rate and maternal mortality rates in our country if this plan 
goes through? That is a legitimate question. The data is clear. You 
restrict access to prenatal care, you endanger children, Americans, and 
you endanger mothers.
  Let's keep asking those questions. What happens to the healthcare 
worker who works 60 hours a week taking care of others but loses their 
own healthcare coverage and then is unable to afford getting screened 
themselves, preventive screenings for cancer--let's say ovarian cancer. 
What happens to them? We don't have to imagine what happens when 
millions of Americans forgo preventive screenings. We have factual data 
on what happens should access to those preventive screenings--like what 
happened with the House healthcare bill--what would happen.
  The American Cancer Society tells us clearly that inadequate health 
coverage is a barrier to preventive care, early detection, and optimal 
treatment. They find, for example, that patients with stage II 
colorectal cancer who have it detected have higher survival rates. In 
fact, they point out that people with stage II colorectal cancer with 
adequate health insurance have better survival rates than people with 
stage I colorectal cancer who have no health coverage. In other words, 
the American Cancer Society shows that access leads to survival and 
denial leads to higher rates of death.
  A recent cancer study found that ``the number of Americans whose 
cancers were diagnosed at the earliest stage when it was most likely to 
be cured increased after ObamaCare went into effect, and more citizens 
had access to health coverage.'' You take away the expanded coverage 
that was founded through ObamaCare, you decrease preventive screenings, 
you decrease early detention and, as indicated by the American Cancer 
Society, death rates go up.
  Another question, in general: What happens to cancer rates in America 
when these gains are reversed? What happens when these gains are 
reversed? What happens to the father of two who is diagnosed with a 
rare cancer who can't afford the additional estimated $82,000? His 
cancer treatment goes up if this bill, like the Republican House bill, 
passes. That is what is estimated--$82,000 is what his cancer 
treatments would go up. What happens when he can't afford that care, 
when he is forced to choose between his family's home, for example, and 
treating his cancer?
  Well, this is what we know. These are the facts that from 2010 to 
2016, personal bankruptcy filings have dropped close to 50 percent in 
the United States of America. One of the collateral benefits of 
ObamaCare is there was a 50-percent drop in personal bankruptcy 
filings, with experts agreeing that the Affordable Care Act played an 
important role in this significant decrease.
  A group of economists has estimated that the House Republican bill 
would cost the average enrollee more than $1,500 more per year than the 
current system. This is despite the fact the surveys have found that 
the majority of Americans have less than $1,000 in savings, with one 
study finding that 63 percent of Americans don't have the savings to 
cover a $500 emergency.
  Remember what Senator Murphy showed? That is a bill that gives 
massive tax cuts to the wealthiest of Americans, shifting the cost 
burden so the average enrollee now under this bill is going to see a 
$1,500-more-per-year payment when the average American doesn't have the 
savings to cover about a $500 emergency.
  Another question that folks are asking is, What happens to the family 
whose child with a disability loses their access to home and support 
services--the physical and speech therapy they receive through 
Medicaid--if the Republican plan goes forward?
  I was in a hospital today with such parents telling me about children 
who--the only way they got the coverage was because of the expanded 
Medicaid. Now what happens under the Republican plan? We know that 
Medicaid is a critical lifeline for people and families with 
disabilities, providing access to services such as rehabilitative 
therapy to help children meet developmental goals.
  One of the incredible young women, girls, I met today--because of 
developmental therapy, she went from not being able to walk to now 
continuing to do the things that her normal teenage peers and her twin 
sister are able to do.
  We know that today, 15 percent of kids are growing up with 
developmental disabilities. In New Jersey, 1 in 41 children lives with 
autism. But this plan that was passed in the House threatens to make it 
more difficult for children with disabilities to receive the care they 
need, to go to school, and to live healthy lives. Losing coverage could 
mean the difference between a child with a disability achieving a 
developmental milestone or falling further behind. Unfortunately, in 
the Republican bill that passed the House,

[[Page S3605]]

that is exactly what will happen if it should become law.
  If that bill passes, what will happen to older Americans who qualify 
for Medicare but still need access to critical health services? We know 
that insurance companies would likely be allowed to charge older 
Americans much higher premiums under the Republican plan. Remember, it 
used to be capped. The cost for older Americans used to be capped. It 
is now being estimated that Americans between the ages 55 and 64 would 
pay some of the highest increases. That increase would be $5,200 more 
per year. Standard & Poor's actually estimated that premiums for a 64-
year-old could increase by 30 percent under the Republican bill that 
passed the House.
  The Congressional Budget Office noted in their report on the House 
Republican health care plan that ``although the agencies expect that 
the legislation would increase the number of uninsured broadly, the 
increase would be disproportionately large among older people with 
lower incomes, particularly people between 50 and 64 years of age with 
incomes of less than 200 percent of the Federal poverty level.'' Think 
about that for a second. Executives of insurance companies, pharma 
companies--the richest will get tax breaks into the hundreds of 
thousands of dollars, but the poorest folks, the elderly in our 
community, according to the CBO, would see their costs go up 
considerably.
  The New Jersey Hospital Association noted that ``under current law, a 
64-year-old making $26,500 a year will pay an average of $1,700 in 
annual premiums.'' Under the AHCA--the Republican plan in the House--
that same individual making just above minimum wage will pay, under 
their plan, between $13,600 and $16,100 in premiums. That is the 
increase for older Americans, working Americans. That is the increase.
  We know that as more older Americans lose their health coverage and 
in turn enter Medicare in worse health, our entire Medicare system is 
made weaker and less solvent.
  If this bill passes, what happens to older Americans who have already 
spent their life savings in nursing homes? We know that right now for 
elder Americans in nursing homes, Medicaid actually covers the cost of 
two out of three of those individuals.
  I will quote from a piece that ran just this past weekend in the New 
York Times: ``Roughly one in three people now turning 65 will require 
nursing home care at some point during his or her life.''
  Over three-quarters of long stay nursing home residents will 
eventually be covered by Medicaid.
  Many American voters think Medicaid is only for low-income adults and 
their children, for people who aren't ``like them.'' But Medicaid is 
not somebody else's insurance; it is an insurance for all of our 
mothers and fathers and eventually for ourselves.
  I continue the quote:

       Mr. Trump and the Republicans would lower spending on the 
     frailest and most vulnerable people in our healthcare system. 
     They would like most Americans to believe that these cuts 
     will not affect them, only their ``undeserving neighbors,'' 
     but that hides the truth that draconian cuts to Medicaid 
     affect all of our families. They are a direct attack on our 
     elderly or disabled and are dangerous.

  I want to wrap up with this concluding thought: We know right now 
that we are at a turning point in our country, that the process that 
has made this deliberative body known throughout the land, throughout 
humanity--that this deliberative body is about to alter its tradition 
and have a bill that affects tens of millions of Americans done and 
crafted in a back room without public input and rushed to this floor. 
That is what the process is right now.
  As Martin Luther King said in a speech to the medical community for 
human rights in 1966, ``Of all the forms of inequality, injustice in 
health care is the most shocking and inhumane.''
  This bill will perpetuate injustice in our Nation. It will further 
the gulf between the haves and have-nots. But it does not just target 
the vulnerable, the elderly, the poor; it targets all of us. It targets 
our character as a country, our highest ideals, the very core of many, 
if not all, of our States. The least of these. The least of these.
  We cannot allow this legislation that will so hurt our country to be 
crafted in darkness behind closed doors. It subverts a mighty tradition 
of the world's most deliberative body to be rushed through and cause so 
much damage to so many Americans and indeed the very soul of our 
country.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER (Mr. Cruz). The Senator from Indiana.

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